Talk:Attention deficit hyperactivity disorder controversies/Archive 4

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Problems with Original Research in the ADHD as a biological illness section

I've been trying to improve the "ADHD as a biological illness section" and I am unhappy that the lines I have given below don't have sources. I am concerned that they are original arguments since the sources of the statements used to support the argument are not directly relevant to ADHD. I decided that these lines ought to be removed until someone can find a source (hopefully a well known critic) who makes this specific argument. I would like to note that I have no problem with this argument being presented in this section; however, someone needs to be accountable for it. Sifaka ^talk 00:58, 19 April 2009 (UTC)

But, critics of Dr. Castellanos’ own research have pointed out that the differences he was claiming do exist could have been the result of medication taken. Even if differences in the brain can be found, an important issue is that the physical brain can be changed by patterns of behavior. Thus learning braille causes enlargement of the part of the motor cortex that controls finger movements. After they have passed their licensing exam, London taxi drivers have been found to have a significantly enlarged hippocampus compared to non-taxi drivers. Monks who meditate show measurable differences in their prefrontal lobes.

Yea they all look like synthesis and original research to me except the last link,[1]. Although it is hosted on a free webhosting service and linking to the original which is on a blog might be problematic.[2] Does anyone know if Simon Sobo is a specialist or researcher of ADHD? If he is then we can link to his blog but if he is just a regular doctor with an opinion then we probably can't link to his blog (if I am remembering policies on citing to blogs correctly).--Literaturegeek | T@1k? 22:35, 22 April 2009 (UTC)

He has published articles on psychiatry and I presume he is a psychiatrist: PMID 19181456 He has also done some editing on the ADHD page however was driven away by Scuro. --Doc James (talk · contribs · email) 23:15, 22 April 2009 (UTC)

Dr. Sobo is/was in private practice and his user name is User:Ss06470. He still seems to be editing. Someone should ask him if anyone has published something on this argument. Sifaka ^talk 01:27, 23 April 2009 (UTC)

Please see Rethinking ADHD, a new book published by Palgrave Macmillan,[3] a very respected peer reviewed publishing house which has a chapter by me (based on my blog ADHD and Other Sins of Our Children You might also be interested in this page [4] which is put together by patients and has links to articles by me some published in peer reviewed journals, some self published. Also this recent article by me that appeared in the peer reviewed journal Medical Hypothesis [5] I can also direct you to comments made about my articles but hopefully this will be enough --Ss06470 (talk) 14:04, 10 June 2009 (UTC)

The book would be a good source to quote as would the peer reviewed source. Why not summarise it and cite it in the article? I don't have the book myself so cannot cite it. If you prefer, you could write up a summary and then provide the page numbers and someone else can cite it for you if you do not know how to use the book citation template.--Literaturegeek | T@1k? 14:48, 10 June 2009 (UTC)

I have not read Dr. Sobo's book, but reading the PubMed abstract linked above, I do not believe that it qualifies for use in Wikipedia for several reasons:

1. Medical Hypotheses .... Really? I'm not really sure whether Medical Hypotheses counts as a "peer reviewed" journal, for starters. Most mainstream medical researchers consider that publication to be a joke, and its "peer review" process has been routinely criticized as being nonexistent. Its articles are rarely if ever cited in other publications, and the only times that I have ever seen it mentioned by reputable researchers is to demonstrate how not to do research.

2. The article in question reads like an opinion piece, and does not seem to imply that any actual research was done aside from "thought experiments." Out of respect for other readers, I will not mention the vulgar slang that academics use to describe "thought experiments" except to say that it rhymes with "dental mastication."

3. The title of the article incorrectly implies that the DSM offers advice on treatment. This is not true, as the DSM is solely a set of diagnostic criteria. Questions regarding appropriate treatment are usually issued in Clinical Practice Guidelines by various specialty societies. Perhaps the full article is more clear on the difference between the DSM-IV and the APA's CPGs, but it is deeply disturbing that the author seems to be unaware of the differences between diagnostic guidelines and treatment guidelines.

3. Most importantly, the article in question eschews Evidence-Based Medicine, derides clinical research as "acting like blinders," the author appears to advocate for granting anecdotal reports the same standing as actual controlled, documented experiments...but most disconcerting is the fact that the author appears to confuse aggregate clinical data with individual results.

Finally, the article specifically states "...what is the best way to formulate treatment strategies when now, and in the foreseeable future, science cannot offer answers that we need?"

If the author is stating that science cannot provide the answers, then I am not sure how one can consider this to be a scientific paper. This is edging a bit close to a "god of the gaps" or an "exceptional pleading" or maybe even an "argument from ignorance" fallacy, and beginning to edge into the realm of pseudoscience.

I would prefer if articles linked from Wiki were actually scientific in nature, and not a bunch of rhetorical thought experiments, rants against EBM, incorrect assertions about the DSM's use in treatment decisions, special pleading to look beyond science and empirical evidence gathering, and treating psychiatry as if it were any different than any other branch of medicine.

I have news for the author of this paper: You might hoodwink a few laypeople, but most educated individuals are aware that the AMA and most medical specialty societies endorse Evidence-Based Medicine, that the AMA and most specialty societies issue their own CPGs and treatment guidelines based upon scientific research just the same as the APA does, and that virtually all branches of Cognitive Medicine utilize the same basic differential diagnostic approach as the APA outlines in the DSM.

Perhaps the author should read through the CDC's diagnostic criteria for Swine Flu, for example, to see how physicians often look for clusters of symptoms to make a differential diagnosis based upon clinical evidence. Medical practice isn't like an episode of "CSI" or "House" where they run a whole bunch of diagnostic tests that magically reveal the answer. It isn't Star Trek where you wave some magical device over someone and it tells you what's wrong with them. While laboratory work and diagnostic testing are certainly useful, the vast majority of medical diagnoses are and most likely always will be made by a basic differential diagnosis based upon clinical research, patient history, and symptom presentation and progression, and this is as true for cardiology, nephrology, dermatology, otolaryngology, rheumatology etc as it is for psychiatry.

Hyperion35 (talk) 15:41, 1 August 2009 (UTC)

Extraordinarily strong words from someone who has not read the literature in question. Medical Hypothesis is a Medline, peer reviewed journal and is far from a joke. Its particular focus is ideas that challenge dominant paradigms. As for evidence based medicine, Hyperion is quite correct that it is the current mindset of most organizations. That does not mean that clinicians are particularly thrilled with it. The problem is that it falsely gives an impression of scientific prestige to findings that are not based on scientific understanding. A treatment is compared to placebo, and if it bests it, the treatment is deemed evidence based. There is nothing wrong with this except many times the treatment is effective 50% or 60% of the time, which while beating placebo, is still treatment without scientific understanding of what is occurring. No one has any trouble with penicillin for strept throat which is going to work 99% of the time because we understand the disease and have the right treatment. The problem is trying to force clinicians to follow evidence based treatments in protocols ( eg one of the proposals currently being considered for health reform is that those who follow evidence based guidelines cannot be sued. Other treatments leave the clinician open to a law suit) One of the key issues isn't that "evidence based medicine" has no value. It is the false impression of scientific validity that it conveys. Its core principle relies on diagnoses, which are in themselves very iffy ... I just realized that I am essentially presenting my article which is easy enough to access.link Pursuing Treatments that are not evidence based I am including the link to my internet version which is free, but those who want to go to Medical Hypothesis are free to do so.Medical Hypothesis —Preceding unsigned comment added by Ss06470 (talk • contribs) 13:10, 10 August 2009 (UTC)

First off, no, Medical Hypotheses does not appear to be a peer-reviewed publication, at least not in the conventional sense. Here is their description of their review process, in their own words, from their own website:

"Medical Hypotheses takes a deliberately different approach to review: the editor sees his role as a 'chooser', not a 'changer', choosing to publish what are judged to be the best papers from those submitted. The Editor sometimes uses external referees to inform his opinion on a paper, but their role is as an information source and the Editor's choice is final. The papers chosen may contain radical ideas, but may be judged acceptable so long as they are coherent and clearly expressed. The authors' responsibility for the integrity, precision and accuracy of their work is paramount."

This is not the standard peer-review process. Technically it doesn't really count as peer-review at all, since nothing is reviewed.

As for the rest...well, by your own admission, this sounds like fringe work. EBM is considered the gold standard in medicine, endorsed by pretty much every medical specialty and subspecialty society. Treatment efficacy with stimulants has been shown to be closer to 70-80%, although obviously other medications for other conditions may have different efficacy values. Regardless, I can think of no other way to determine the best treatment aside from trial and error. The entire point of EBM is to avoid having to use each individual patient as a guinea pig due to a lack of information about what might be the best treatment.

And finally, if medicine is not to rely on diagnoses...you know what, I don't think there's a point to rebutting that, I'll just let that last statement stand. If medicine is not to rely on diagnoses or on the use of evidence to determine the best treatment, then we may as well throw out every major medical advance in the past 200 years. Your statements speak for themselves. If you would like me to ask for an outside opinion on this from an uninterested editor from the Wikiproject Medicine, I can, but you're just going to get the same answer. ~ Hyperion35 (talk) 14:23, 10 August 2009 (UTC)

Hyperion, I think that you have given this debate long enough now and it is irrelevant to this article. The only support that Ss06470 got was for citing the book but for some reason you have went off on a tagent triggering a debate and Ss06470 has fueled it by responding, I would ask you both to stop. The sources other than the book are not reliable sources, so are not relevant to this discussion, which has deteriorated into discussing each other's beliefs and whatnot, such discussions are counter-productive. I recommend that forum like debates are at least moved to someone's talk page or else perhaps you could give Ss06470 your email address and you can continue this debate. Ss06470, I asked if you would be willing to summarise the book in a few sentences or paragraph for consideration for citing but this has not happened. I cannot as I do not have access to the book.--Literaturegeek | T@1k? 15:58, 10 August 2009 (UTC)

I'm sorry, I was under the impression that the Medical Hypotheses article was being cited, either on its own or as a substitute for the book citation. If it is not being offered as a citation, then obviously there is no further point to discussing it. ~ Hyperion35 (talk) 18:46, 10 August 2009 (UTC)

Response of Dr. Simon Sobo

Literature geek sorry, I cannot let Hyperion have the last word on the issue of the shortcomings of diagnostic pschiatry. I am not taking a position like Szaz that there is no such thing as psychopathology. Clearly there is, but diagnostic labels are not always the best way to understand this pathology. It isn't only that efficacy is not where we would expect it to be if we had a good grasp of the issues through scientific understanding. As I note the diagnoses themselves may not represent real illnesses. Yes one can, and should, for research purposes, take a stab at operational definitions of the phenomenon you want to study. But that doesn't mean that something like, for instance, oppositional-defiant disorder represents an actual disease like diabetes, pneumonia, carcinoma and the like. Yes you can define what everyone will agree to call oppositional defiant disorder, and find patients that fit this description, but that doesn't mean it is a disease. Trying treatments out on this "disease," even if it reaches evidence based confirmation, does not mean it will be the correct treatment for an individual before you. There are so many reasons a child can become oppositional and defiant. What you call my preference for anecdotal results, based on the treatment of individuals, is simply trying to understand where a particular individual is coming from. Thinking of everyone who is oppositional and defiant as being the same as everyone else showing the the same behavior is an example of how DSM IV can act as a blinder

But even if we leave aside the crudenss of diagnoses that are so uncertain they are called (for this very reason) "disorders" in DSM IV rather than "diagnoses", the key issue I was addressing is what do clinicians do when the evidence based treatment isn't working. Are we only allowed to consider evidence based treatment or can we consider other strategies. More to the point, shouldn't clinicians be writing about their case histories and discoveries so that we can create a literature that is rich in intuitions or should it all be barred as nonsense since it is not evidence based.Italic text'' The limitations in our scientific understanding are so great that the literature should be rich with the sharing of sensible insights with each other. You see this as using patients as guinea pigs. I see it as the kind of clinical judgement that has always characterized the best medical practice , and which, by the way, often leads to the kind of scientific discoveries we are all waiting for. That you can't see this as necessary tells me that you are not a clinician, but rather an academic who isn't forced to come up with solutions for real patients looking to them for help other than offering a clinical trial (speaking of guinea pigs)

To repeat, we have no need for intuitions and insights when we get to the promised land of scientific understanding (my example of penicillin for strept throat) where we clearly know what we are doing and why. This is the wonderful result of scientific discoverie. Claiming the prestige of science when the knowledge isn't there is pseudo science. Yes scientific method is being followed, but not the highest quality of science, absolute clarity about what is known and not known. Evidence based medicine as ideology obscures this crucial point

Finally, I just don't get this policy of user names. One of the most important qualities of scholarly discussion is that people identify themselves. This site is full of pedantic distinctions in the interest of intellecutal balance, but annonymous posters are certainly detrimental to a reasonable airing of issues,--Ss06470 (talk) 03:26, 11 August 2009 (UTC) Simon Sobo, M.D

I would like to add the last paragraph of the article in question to the above because more than my meandering here it captures the spirit of the article. It is hardly, as hyperion implies an attempt to "trick" anyone

"The core issue is our approach to patients. Evidence based medicine eschews the anecdotal in the name of generalized conclusions, based on the odds that the patient’s ailments are typical for their group. This is not a ridiculous consideration, but it can miss important particulars brought by the patient. Knowing a patient well can be the difference between effective and ineffective treatment. Premorbid defenses, character style, the nature of the patients’ stressors, their story can guide clinicians to a particular medication, and influence dosage. While evidence based medicine has a place, especially when low cost is a consideration, it cannot lay claim to being optimal treatment. It is especially detrimental if this perspective acts like blinders, obscuring more than it clarifies."

One last point for hyperion. I don't understand how you thought I haven't distinguised between DSM IV and treatment guidelines. More than anything else it tells me that your strong haughty opinions are based on very superficial reading . There is simply no way you could conclude that I don't understand this distinction if you actually read what I wrote Why don't you take a look at the article itself rather than blasting it based on a reading of the abstract. It contains some fundamental questions about diagnostic psychiatry which you might find interesting. Or are you so caught up in your universe that stepping out of it might cause you to become disoriented.--Ss06470 (talk) 11:19, 12 August 2009 (UTC)

WP:SOAP ~ Hyperion35 (talk) 14:56, 11 August 2009 (UTC)

This interchange brings out one of the major unresolved problems on Wikipedia: how to treat experts. Dr. Sobo is an expert, he is a clinician and a published author in the field. He is probably best treated as having a conflict of interest, and thus restricted to giving us advice in Talk. Hyperion, above, cites WP:SOAP, and, if we take this as a literal prohibition, we lose the advice of an expert. Because I'm currently involved in a highly contentious Request for Arbitration, I'm going to proceed very carefully here, but I've decided to do this: I'm going to delete Dr. Sobo's response and replace it with a pointer to page history so that anyone can read it with one click. Dr. Sobo may revert this if he chooses, the intention here is not to offend, but to seek consensus and avoid useless debate. Dr. Sobo's response is worth reading, in my opinion, but it also skirts the edges of what is allowed, and this commonly occurs with experts. --Abd (talk) 15:25, 11 August 2009 (UTC)

Dr. Sobo, you reverted my action; since you wanted to edit your comment, are you done? May I remove it again with a new link, or it would be better if you did it. My point is to keep it accessible and readable, but to avoid certain other problems. Okay? --Abd (talk) 12:13, 12 August 2009 (UTC)

An article published in medical hypotheses can be used. Not every thing needs to be peer reviewed. So yes one could go ahead and quote this. It is not like Wikipedia needs to save disk space.Doc James (talk · contribs · email) 08:23, 25 August 2009 (UTC)

Actually no, WP:MEDRS specifically mentions Medical Hypotheses as being a source to avoid:

""Still others, such as Medical Hypotheses, publish speculative proposals that are not reliable sources for biomedical topics.""

Few people within the medical community consider Medical Hypotheses to be a reliable source. At best, MH is a compendium of ideas that might make good research proposals at some point in the future...although even that would probably be questionable. ~ Hyperion35 (talk) 16:18, 23 September 2009 (UTC)

ADHD Issues where there is active debate

I've made a list of topics in ADHD where there is active debate. Some issues are primarily debated in mainstream psychiatric practice and research, others are debated more in "laypeople land," and some are in both. If I omitted something egregious, please add it to the list. Do note I'm not picking sides on the debates presented, only trying to offer what is in my not so distinguished opinion the level of discussion in various communities. Whether or not these collectively constitute "controversy" is up for consensus, but I thought it would be a good idea not to pigeon hole the topic of conversation on one debate alone. Sifaka ^talk 03:46, 29 April 2009 (UTC)

1. Does ADHD exist or not exist?

• Not really debated in maintream research or practicing communities. I would go so far as to say a significant number of lay people believe it exists.
• S-mand said: Natural trait called disordered. Potentially.
• Hordaland says: The laypeople who say it does not exist are many: bogus, bad parenting. (Hard to source.) Organized resistance must be mentioned: Scientology, Anti-psychiatry, social rather than individual problem.
• * Many different communities dispute the ontology of ADHD, and not just based on 'bogus' reasoning- the fact that there is no scientific, consistent diagnostic criteria, and the geographic, cultural, and historical isolation of epidemiology, are strong indicators of the fact that ADHD is likely pattern of behavior with its origin in environmental factors, not a neurological disorder. —Preceding unsigned comment added by RebelBodhi (talk • contribs) 02:32, 7 July 2009 (UTC)

I don't disagree, RebelB, and I think my comment just above was ambiguous. I meant to say that laypeople who say that ADHD does not exist are many, and they think that it is a bogus diagnosis and/or it's due to bad parenting. - Hordaland (talk) 12:24, 7 July 2009 (UTC)

2. Should ADHD be considered a disorder?

- Will it hurt the children to say they have a disorder? Should people with ADHD get any special benefits?

• In the mainstream end of things, people who meet patients care more about this than the researchers. It's more mainstream than "fringe". I'd call it an "alternative theoretical formulation".
• Legally it is considered a learning disability and schools and workplaces and whatnot are required to provide accommodations.

3. "Special cases" of ADHD : Valid or Not?

• Sub-clinical ADHD: If valid, do we do anything differently?

• I know almost nothing about it, but I know it comes up in respectable places in research from time to time. I don't know how well the idea has caught on.

• Adult ADHD

• Definitely has gained a lot of mainstream steam. The laypeople community has been slower to pick it up.

4. What are the biological causes of ADHD?

- Environmental, genetic, diet? What proportion is genetic and what proportion is environmental? Do the different causes of ADHD affect the presentation of the symptoms?

• Debate is mostly in the research community. They're so many unknowns it's hard to argue. However researchers have seem to rule out most aspects of diet as a part of ADHD.

5. Does the current ADHD diagnosis criteria allow too high a rate of misdiagnosis or over-diagnosis and if so what is the best way to fix it?

• Reminds me of lines like: "children with problematic behavior" "students who want to use stimulants to get a study edge" "fad diagnosis"

• Active debate in the mainstream psychiatric community and very often in "layperson land."

• The difference in diagnosis rates between girls and boys means we don't have it quite right yet. Who is the best source of information in the diagnosis: teachers, parents, the child themselves. We need to account for differing cultures... etc

• Debated both by the psychiatric community and the lay-people at large. Mentioned all the time by review papers.

Perhaps it's just that boys hit their heads against things harder and more frequently than girls, causing more -- but accumulative -- very slight frontal lobe damages. htom (talk) 04:26, 29 April 2009 (UTC)

Let's don't get into the girl/boy statistics. One argument is that cavemen had to be active while cave-women just sat there and nursed babies. Thus, twice as many boys... - Hordaland (talk) 09:36, 9 May 2009 (UTC)

• S-mand said: Diagnostic criteria controversial?. No, I dont see that. All professionals afaik thinks they must be improved. Public aspect? Can't really see it.
• S-mand said: Overdiagnosis. Absolutely an issue.
• S-mand said: Underdiagnosis. Probably an issue. But controversial?
• Hordaland says: Major problem for the public. Recently medical & research people are recognizing this, that too little work is done to find differential or comorbid diagnoses. For example, Barbara Fisher says, page 35: “If children do not get restorative sleep at night or they have insufficient sleep or sleep deprivation, daytime symptoms can easily mimic hyperactivity. By remaining active during the day, children can stay awake.” She also talks at length about anxiety causing ADD symptoms.

6. What is the best way to make a diagnosis?

- Repeated office meetings, a battery of cognitive tests, observation, circle the number and add up the score type tests?

• Definitely debated in the mainstream psychiatric community, especially when the issue of too many diagnoses or misdiagnosis crops up.

7. Best, if any, treatment method:

Stimulant medications versus alternative medicine versus no treatment at all?

• Overwhelming support for stimulants in the mainstream community, but a google search for ADHD treatments suggests that natural remedies are marketed heavily to laypeople
• There is a subtle element of the alternative medicine practiced by mainstream psychiatrists: a doctor may recommend taking omega three supplements alongside stimulant meds because it couldn't hurt and maybe it would help. In my experience, it's not uncommon for doctors to mention some of the alternative stuff when talking ADHD, but only as supplementary treatment.

• The FDA and the pharmaceutical companies seem to disagree about how effective stimulants are for ADHD. I submit [6] and [7]--Doc James (talk · contribs · email) 10:31, 9 May 2009 (UTC)

• • Best treatment is going to depend upon the patient. This is a spectrum disorder, and someone who has it making a severe impact may require very different treatment than someone with minor impact. This is a little more complicated than a broken leg -- which also has varying best treatments, depending on the patient. htom (talk) 15:59, 14 June 2009 (UTC)

8. Use of stimulants

When and when not to use stimulant medications versus other options (ADHD coaches, nothing all, etc.) -Is the long term use of stimulants effective and are they necessary? Is there a lower age limits to when a child should start? Is it ever too late to start stimulant meds? Should stimulant meds only be taken when needed or all the time? What about when the abuse potential is high?

• Very much a major debate in the psychiatric and research community.
• S-mand said: Treatment with Stimulant and its (ab)use. This is probably the main public controversy.

9. media & big pharm

• S-mand said: Media coverage and interest. Sales before science.

Thanks for this section, Sifaka; can't hurt, might help. I'm a layperson, though as an elementary school teacher, some might allow me a degree of expertise. ;-) I am most concerned with your point #5. Obviously, doctors should always rule out other explanations of the symptoms before diagnosing ADHD. I believe that this isn't taken anywhere seriously enough in the case of ADHD. For example, treating sleep deprivation/disturbances of various causes such as delayed sleep phase syndrome, narcolepsy and sleep apnea has removed children from the ranks of ADHD sufferers. (No, I don't have one source demonstrating that.) That ADHD is a fad and a catch-all is a reality; the pendulum has swung way too far in that direction. - Hordaland (talk) 21:17, 30 April 2009 (UTC)

• Comment - The first sentence of the article should describe what the controversy about ADHD is. Statements about how controversial it is can follow, but only after what about ADHD is controversial has been described. LK (talk) 16:01, 8 May 2009 (UTC)

You are right, LK. I fear there are so many subsets of controversial areas that it will take more than 1 sentence. But we're on the right track. Input is welcome. - Hordaland (talk) 02:08, 9 May 2009 (UTC)

removing POV tags without discussion

Certain editors continue to remove POV tags unilaterally from the article without discussion. I will be seeking action shortly for such behaviour and wanted to let all members of this community know that anyone who continues with this behaviour will be a party mentioned on the complaint. This behaviour is wrong and goes against wiki policies.--scuro (talk) 16:05, 27 April 2009 (UTC)

Good luck with that because "drive by tagging" without discussing the content of the dispute on the talk page is strongly discouraged. See WP:NPOVD. You are fast turning the talk pages into a drama based forum or chat site. Perhaps that is your intention?--Literaturegeek | T@1k? 08:50, 28 April 2009 (UTC)

I am discussing content, specifically citation 12, but I did bring up a number of generalized observed shortcomings of the article. I choose to keep the discussion in a very narrow band so that criticisms should also be narrowly focused on one specific piece of content. That a number of members have trouble focusing on one specific piece of content justifies the approach.--scuro (talk) 14:06, 28 April 2009 (UTC)

How about we introduce a "seconding policy" with major article tags - what I mean is that if someone wants to add a tag or remove a tag, they ask on the talk page and wait for their request to be seconded before adding/removing the tag. That way, there is at least some feedback between users regarding tags, the tagger must be specific in explaining why the article needs a tag or how the content has been fixed so it doesn't need a tag anymore, and a section for discussion automatically gets made. Sifaka ^talk 06:06, 29 April 2009 (UTC)

Feedback is nice but your policy would go against current policy. A second "vote" isn't justification to remove a tag nor is it required to add a tag.--scuro (talk) 11:44, 29 April 2009 (UTC)

Explain Scuro how it goes against current policy. Please be detailed and give links to the appropriate section of the appropriate policy pages. I'm suggesting this additional level of regulation to prevent edit warring over something unrelated to article content. Sifaka ^talk 16:55, 29 April 2009 (UTC)

Here is a link that some contributors really must internalize.WP:OWN But I think the link you are looking for is this one. WP:DEMOCRACY I appreciate it that you don't like edit warring. But I am feed up with this environment of lawlessness. Where contributors can hijack a page and keep any edit of another contributor off the page simply because they believe that they are wrong, or haven't met some expectation which moves whenever the criteria are met. I've tried mediation twice and this contributor simply let the mediation end with no resolution. Really I think it is time that administrators step in. I'm done with jumping through Wikipedian process hoops to file some lengthy mediation process that in the end has no teeth. I get the lead by example, expect the best in people approach...but it's been months and months and nothing has changed. Why should other contributors endlessly suffer? I'm not playing nice anymore until I see change.--scuro (talk) 21:31, 29 April 2009 (UTC)

Concerned about the Concerns over research section

I've removed the section and put it here.

Concerns over research

There is a significant amount of controversy surrounding ADHD in the medical, psychological, academic and educational communities. Some involved in this controversy have described the arguments used in support of ADHD as phoney, scientifically weak, fallacious, and similar to the tactics used by politically biased major news networks. According to philosophy professor Gordon Tait, fallacious arguments have often been used by advocates of ADHD to support their position. These fallacies include material, psychological and logical fallacies. It suggests that all researchers, whether into ADHD or otherwise, "need to pay much closer attention to the construction of their arguments if they are not to make truth claims unsupported by satisfactory evidence, form or logic."

There are quite a few problems with this.

First is that the section has nothing to do with research. Looking at content and the source, this section is really about alleged poorly constructed arguments used to support ADHD as a disorder. The title has to be changed to something else.

I think this source is sketchy. It should not be used as support for the existence of "fallacies" because the author offers no support that the fallacious arguments he presents are actually used. Although I haven't looked into it much, the sources he bases some of his claims on may be questionable themselves. I really think an alternative source should be found. Most of the fallacies he brings up are really concerned with issues addressed in other sections like over diagnosis, misuse of stimulants, etc where we have much better sources.

Finally, I think this source is of poor quality because it contains some really questionable arguments. I'll outline a few of what I thought were the worst offenders below in case you can't get the paper because of paywalls. Sifaka ^talk 22:02, 19 May 2009 (UTC)

(1) Golden Mean Fallacy - This fallacy is based upon the pre-existence of two contrary, or widely divergent, positions. Faced with the difficulty of choosing between those positions, a compromise solution is reached when both elements are incorporated into the conclusion. This argument is a fallacy since nothing in the premises provides any support for that conclusion. ... It is estimated that 1–12% of school age children are affected by ADHD, with 3% the consensus estimate.

This is a terrible argument because it misrepresents how prevalence rates which are likely to be considered "consensus rates" are determined. The claim the author makes is that 3% consensus number was decided because it is a compromise between 1% and 12%. While I can't be sure of what the author was thinking when he wrote this, it sure seems like he's saying that there were two figures: 1% and 12%, and that the number 3% was chosen as an average between the two. The prevalence rates which are likely to be considered "consensus" are calculated with considerably more care, thought, and scientific rigor. While essentially the consensus number is an average, it's a weighted average with a confidence interval. See this study's methods and discussion.

(3) " Weak Analogy Fallacy" - ADHD is often compared to a wide range of common, unproblematic illnesses and diseases, everything from pneumonia to mumps. However, this is ultimately a weak analogy which attempts to mask a significant problem with the psychological construct of ADHD, in that there appears to be no objective physical evidence for its existence at all—‘no physical symptoms, no neurological signs, and no blood tests’ (Breggin 1998, pp. 141–142).

The lack of an objective diagnosis does not mean ADHD does not exist; there may eventually be an objective diagnosis for certain subtypes (like genetically linked ADHD). Also, the statement that there is no objective physical evidence for its existence is also wrong. The pathophysiology section lists quite a few studies which demonstrate statistically significant findings of differences between people with ADHD and without. While some claim the results are not conclusive or have confounding factors, it is really irresponsible to completely ignore the existence of these studies altogether. Also I'm not sure Peter Breggin can be considered a reliable source here.

(4) "False Dichotomy" -This logic is particularly common within ADHD commentary, particularly, it seems, from doctors. What can be a very complex problem is distilled down to two simple alternatives i.e. take Ritalin, or become a drug-taking criminal. Clearly, as one of these options is spectacularly undesirable, the taking of Ritalin is not only logical, it is all-but necessary. This argument can be seen across a range of different contexts, but always with the same fallacy firmly in place: it’s either Ritalin or a chaotic classroom, Ritalin or a dysfunctional family. This is not a real dilemma. The alternative is so disagreeable as to be redundant, and it also neglects all the other options available to the good teacher or the good parent, options which remain viable for addressing specific kinds of unwanted behaviour. This is the case whether ADHD is accepted as a valid disorder or not.

This really is a wall banger. Despite what he claims is common rhetoric from doctors, I strongly doubt that anyone professional says "take Ritalin or become a drug-taking criminal." He offer no evidence in support that this is common discourse. Sifaka ^talk 22:02, 19 May 2009 (UTC)

Thank you for your commentsI don't mind the title being changed. He does use evidence that the arguments are used by referencing peer reviewed literature and sometimes if I remember correctly directly quoting arguments used in the peer reviewed literature. He used like 70 or so references, only one of which was to breggin if I remember correctly. I think that some of his arguments have a point and are valid. I don't necessarily agree with all of this authors points but that doesn't mean that it shouldn't be cited. The genetic traits does not prove a disorder in everyone's mind. One would find genetic traits no doubt for people are poor sportsmen at school but does this mean a disorder but one could say it was a disorder if sportsman like skills were required eg in a society where one needed to be good at running and coordination for say hunting eg 3rd world countries. ADHD is controversial and I have added some literature on the controversies but I don't necessarily agree with all of the data that I have added, I don't but equally I don't agree with all of the data from the other point of view added. I have read arguments in the peer reviewed literature and also heard from pediatricians who have stated that ADHD untreated can lead to drug addiction and increased crime infact I watched a documentary on discovery channel with doctors talking about how untreated ADHD can lead to crime and drug addiction etc. I don't think that the entire section should have been deleted for the reasons outlined but I am happy to discuss.--Literaturegeek | T@1k? 23:50, 19 May 2009 (UTC)

The author uses quotes for some of the arguments he presents but there is no indication of the context they're in, and it seems pretty likely to me some of the quotes are taken out of context. I still haven't looked into his sources in general, but using Breggin for the one spot I pointed out was definitely not good. Whether or not he makes some good points is kind of besides the point. He makes quite a few bad points too and also uses a lot of terrible arguments to try and support his points. Even though he lists lots of sources, there are few in-line citations to support any of his major points. Furthermore, according to my OR, there are some blatant factual errors. "As the examples I have chosen accurately illustrate the dominant arguments employed when discussing the disorder. Not only are they regularly used within the academy, they are also the most common discourses employed at the twin coalfaces of the classroom and the living room—and more often than not, they are fallacious." If "by the academy" he means "in scientific discourse", I have never read a research paper which makes the statements he says they commonly do. While it is likely someone somewhere has made some overreaching statements of the kind he proposes, it is the exception and not the rule. This is really an unprofessional and less than satisfactory source.

Also, a lot of his points are very similar to other issues brought up in status as a disorder section and also some of the social construct theories sections (such as ADHD is not a disorder because there is no objective diagnosis). I don't see this section adding any real additional value to the article; this section would only be reduplicating the points made in these sections. I've been trying to streamline and classify a lot of the content to prevent the article from becoming a lengthy catalogue of debate and rebuttals where deluges of information obfuscate the big picture. Effectively I'm trying to avoid lots of sections which go along the lines of "this guy says A, mainstream science disagrees and says X." It's far more readable and informative to categorize this article by types of arguments than try to categorize it by people who make the arguments. Sifaka ^talk 01:36, 20 May 2009 (UTC)

The professional slide deck for Focalin does say untreated ADHD causes drug addiction and implies that taking this drug from Novartis prevents it. http://www.fda.gov/foi/warning_letters/s6935c.htm For this they got a warning letter from the FDA.--Doc James (talk · contribs · email) 01:49, 20 May 2009 (UTC)

Good example, but I still hold that this kind of discourse isn't common - in my experience it's the exception rather than the rule. Do note that most of my experience is in research rather than marketing. Keeping in mind my OR isn't worth anything, there are still lots of other problems with the source including the use out of context quotes (1, 2, 3, 5, 8, 10, 11 are probably taken out of context but I can't check all of them right now), quotes which use outdated/incorrect information (12 - the response to stimulant medication is not considered diagnostic), or use incorrect information/misconstrue the quote entirely to make an argument (9 - genetics are a factor in 75% of ADHD cases and hyperactivity also seems to be primarily a genetic condition, so there is a good reason to suspect ADHD when other family members have ADHD) to support the notion that these fallacies are used in regular discourse. Sifaka ^talk 02:43, 20 May 2009 (UTC)

I agree that these discussions are not common and that a lot of these arguments overlap. To take "the response to stimulant medication is not considered diagnostic" for example. Some physicians say lets try stimulants and if they work that must mean you / your child has ADHD. The only published study we have was many years ago but showed stimulants work in all people. Recently some are even promoting stimulant use for the general population see cognitive enhancers. And of course the US airforces uses them. No further trials have been done with stimulants in the general population as far as I am aware.

I am not sure if a drug works for everyone does the FDA then allow you to advertise it to everyone? This is part of the reasons why stimulants are controversial and have been compared to mental steroids.--Doc James (talk · contribs · email) 17:38, 20 May 2009 (UTC)

I agree that a positive response to stimulants are often used incorrectly as diagnostic evidence for ADHD. This is due to the myth that is widely believed even by health professionals that improved attention and calmness is a "paradoxical effect" of CNS stimulants and that other people get stimulated on stimulants. At moderate doses CNS stimulants calm people down by increasing attention and alertness regardless of ADHD diagnosis or not. It is higher or excessive doses which make people high, excessively energetic etc. The myth exists because people don't realise the different pharmacological behavioural effects from moderate versus high or very high doses of amphetamines and their derivatives.--Literaturegeek | T@1k? 23:35, 14 June 2009 (UTC)

this looks controversial but not sure where it should go. Does someone else wish to add a line in here somewhere

Attorney Stephen Sheller is suing Janssen, which makes Risperdal. He claims Janssen marketed Risperdal for unapproved uses in children, downplayed serious risks like diabetes and seizures.

see video[8] on recent breast development of teenage boys treated with risperdal for ADHD Earlypsychosis (talk) 11:35, 27 May 2009 (UTC)

Interesting, thanks. I don't think that it is specific enough for this ADHD article. If it is worth citing it would be worth citing in a small controversy section in the risperidone article rather than this article. Here is another citation for that story.[9]--Literaturegeek | T@1k? 23:59, 14 June 2009 (UTC)

I agree with Litgeek here. The risperidone article seems to be the place to put it. It could also use a mention in Janssen Pharmaceutica. Risperidal doesn't mention that it is used even off label as an ADHD treatment. Sifaka ^talk 01:53, 15 June 2009 (UTC)

foodstuff causes

Studies should have already been initiated and completed that investigate the relationship between ADHD and ungulate milk/cheese/ice-cream/butter product ingestion. Lifetimes of such nourishment behavior include serious doubts about the sanity and motives of providers. beadtot66.217.68.79 (talk) 02:10, 6 June 2009 (UTC)

You are going to need to find reliable sources for this if you wish to add this information to the article. Should you find said reliable sources, in the interest of NPOV you are going to have to leave off the line about the sanity of providers. Sifaka ^talk 01:57, 15 June 2009 (UTC)

My girlfriend is lactose intolerant. I can assure you that the symptoms associated with ingestion of ungulate milk/cheese/ice-cream/butter, while extremely unpleasant, do not resemble ADHD at all. Also, while no studies have directly compared ADHD and lactose ingestion, it is quite well known that the ability to digest lactose varies among people of different ethnic/genetic backgrounds. However, despite the fact that there are great differences in the prevalence of lactose-digestion abilities across different ethnic groups, there is very little evidence of any differences in ADHD prevalence between various ethnic and racial groups. Note that *prevalence* is not the same as *treatment/diagnosis/prescription rates* which obviously might vary based upon country or socioeconomic status or whether one has health insurance.

And of course, this ignores the fact that examining a relationship between ADHD and dairy product consumption would be extremely difficult due to the fact that dairy product consumption is fairly common (in the US at least) for both ADHD and non-ADHD individuals. It would be as difficult as investigating a relationship between consumption of bread and ADHD, or the consumption of fruit juice and ADHD. You're looking at something consumed by a large number of individuals who are both positive and negative for the condition. You're simply going to have far too much useless data that the "noise" is going to obscure any meaningful information. Hyperion35 (talk) 14:12, 1 August 2009 (UTC)

Scientology

Is the section about Scientology really necessary? There are many religious groups that oppose psychiatric treatment, maybe we could generalize this a bit (and include Scientology as a specific example).

If some churches are anti-drug, the would oppose stimulant treatment of ADD (and maybe SNRI treatment as well).

Jacob.vankley (talk) 19:54, 12 July 2009 (UTC)

I have a good ref that comments on this. It explains that many concervatives have concerns with the diagnosis of ADHD as it weakens the central role of parents in the family. Will post in a weeks or 2 when I am back.--Doc James (talk · contribs · email) 22:53, 12 July 2009 (UTC)

Scientology deserves a special mention for their somewhat extreme efforts to oppose the use of any psychiatric medications, including those used for ADHD. Furthermore, unlike other religious groups that might prohibit their followers from using particular substances (LDS and Islam both forbid alcohol, for example), Scientology has actively sought to stop non-believers from consuming these substances, even going so far as to file lawsuits against Novartis (the makers of Ritalin), and setting up numerous websites such as ritalindeath.com through various front groups. The Church of Scientology also operates the "Citizen's Commission on Human Rights" whose only goal, it appears, is to convince patients to ignore their physician's advice and file lawsuits against anyone who disagrees.

To this extent, it is no different than mentioning the Catholic Church in an article on abortion, as they are a prominent and vocal religious group who have taken a public stance in favor of banning that procedure for all individuals, not only their own followers. In this case, the issue is not so much that the Church of Scientology forbids the use of these drugs for their followers, but their public (and sometimes not-so-public) actions that they have taken.

After all, if a Muslim organization were to sue Anheiser-Busch or Bacardi, or if a Jewish organization were to sue The Honey Baked Ham Company, or if a Jehovah's Witness organization were to sue the Red Cross blood banks, that would probably also be something that might be worth noting in an article on alcohol or pork or blood banks. Hyperion35 (talk) 14:35, 1 August 2009 (UTC)

reverted deleted text

Text deleted from the passage was returned.[10]--scuro (talk) 15:58, 15 July 2009 (UTC)

In the section about media issues I have added a phrase which puts the LA Times quote about scientology being the main cause of ADHD opposition. If left alone, as the summing up statement of that section it erroneously implies that everything that comes before it derived from scientology, an absurd conclusion--Ss06470 (talk) 02:39, 21 July 2009 (UTC)

Section: "ADHD in politics and the media"

I've just mangled rearranged this section, removing some redundancies. I looked at it in isolation - haven't compared it to rest of article (yet). Thus some of my {fact} and {when} tags may be unnecessary... - Hordaland (talk) 18:59, 21 July 2009 (UTC)

"Stimulant misuse"

This section looks to me to be very blatantly applicable to the USA only. If that's the case, it should be stated. Is "Schedule II" an international term? The review from Harvard represents more than 100 000 subjects. Impressive. But the abstract doesn't say if they are/were all in the USA, in North America or perhaps elsewhere. - Hordaland (talk) 12:03, 23 July 2009 (UTC)

Agree.--Doc James (talk · contribs · email) 13:01, 23 July 2009 (UTC)

OK, so you were tempted to say "just do it"? I did google 'Schedule II' to try to find out. Found a pharmacist who says it applies differently in different countries. Didn't quite answer my question. And the Harvard abstract doesn't say where the subjects were. So I did try :-) - Hordaland (talk) 05:24, 24 July 2009 (UTC)

The term "Schedule II" refers to the legal regulations that apply to Amphetamine (and other drugs) in the United States. The 1970 Controlled Substances Act allows the FDA to classify controlled substances into several different categories, or "Schedules." These classifications place limits on the number of refills that can be allowed or the amount that can be dispensed at a given time. It also places recordkeeping and storage requirements for pharmacies when storing and dispensing these drugs.

Other countries do have different regulatory classifications for drugs (I believe that the UK uses letters instead of numbers, for example), but the general concept is usually similar. Some drugs need to be tightly controlled, others less so. A pharmacy can't lock up all of the drugs that might possibly be abused, but it does make sense to put the stimulants and painkillers in a higher category than a mild anti-anxiety drug, for example.

Generally, the drug classifications for most Advanced Industrialized (ie "First World") nations tend to be pretty much the same. There are a few minor differences, such as where heroin is often used as a painkiller in medical practice in the UK (as "diamorphine"), but is considered to have no medical use in the US. Cannabis is another substance whose legal status varies from country to country, especially in Europe. However, Amphetamine and Methylphenidate generally tend to have similar legal and regulatory classifications in most Advanced Industrialized states, usually placed in one of the more restrictive but still "medically acceptable" classifications, similar to many painkillers. And just like with painkillers, they can be abused, but also have legitimate medical uses, and abuse is not often an issue when used in the course of proper medical care.

Also, this section is a bit misleading, as it fails to mention studies that have shown that substance abuse problems are far more prevalent in unmedicated persons with ADHD than in those taking medication. Hyperion35 (talk) 14:59, 1 August 2009 (UTC)

Excellent so reference this and add it for balance.Doc James (talk · contribs · email) 15:46, 17 August 2009 (UTC)

Removed misquoted information from "Social Construct Theory" section

I have removed the following statement from the "Social Construct Theory" section of the article, as a check of the source found that it had been misquoted.

The initial passage was as follows:

"Social critics question whether ADHD is wholly or even predominantly a biological illness, pointing out the wide differences in diagnosis rates around the world, with America having six times the rate of diagnosis than Australia eight times that of Spain and sixteen times that of Chile" Source

When I checked the source, I found that they stated this:

"The per capita consumption of methylphenidate in the United States between 2003 and 2005 was approximately six times greater than that of Australia, eight times greater than that of Spain, and 18 times greater than that of Chile (3)."

Please note that the source was discussing consumption of methylphenidate, not diagnostic rates.

What is even more ironic is that this source is a non-peer-reviewed letter to the editor regarding a previous peer-reviewed study that had been published in that journal. The study that prompted this letter had concluded:

"CONCLUSIONS: Our findings suggest that geographic location plays a limited role in the reasons for the large variability of ADHD/HD prevalence estimates worldwide. Instead, this variability seems to be explained primarily by the methodological characteristics of studies."

Please remember to read through the sources that are being cited before creating edits. Obviously I am assuming that this was a good-faith mistake, but it is rather disturbing that the result was that a letter to the editor of a journal was so dramatically misquoted as to misrepresent the findings of the original study. ~ Hyperion35 (talk) 02:08, 22 August 2009 (UTC)

Made Several Edits, More Cleanup Needed

I have made several edits to the page today, and some of this probably needs to be discussed. I've only begun to scratch the surface, but I've found numerous factual inaccuracies, omission of information, misquotation, etc...and this was only in a few minutes. Changes worth mentioning:

Teachers do not make the diagnosis of ADHD. I don't really care whether people are concerned that teachers might misdiagnose a child as having ADHD, because...and this really should not be difficult to grasp: teachers don't make the diagnosis anyways. This is every bit as irrelevant as concerns that the mailman, grocery store clerk, auto mechanic, dentist, babysitter, or gardener might misdiagnose a child with ADHD. Also, one of the citations was a dead link to a political activist website, not exactly what I would consider a reliable source. Coaching tip: If the website is called www.mykidsdeservebetter.com, there's a good chance it's not going to be the best source out there, k?

I also made changes to the Outside North America section to reflect the latest guidelines from the UK. I was originally going to leave the 1997 BPS study in, but there really was no way to do so without making the authors of that study look foolish. In addition to the UK guidelines from NICE, I also added in information from a systematic review of worldwide prevalence studies that was mentioned in those guidelines. The remaining citation is to a source in Norwegian, I think. I do not speak Norwegian, does anyone have a translation?

The Skepticism of Diagnosis section cited a 2002 BMJ survey that supposedly listed ADHD as one of the top "non-diseases." The problem is, the full text of that study is available to read, and guess what? No mention of ADHD or Hyperkinetic Syndrome, or any other related condition. This sort of factual inaccuracy, combined with the semi-misquotation of Dr. Frances, calls into question a lot of different citations on this page. I've got a suspicion that there are probably more factual inaccuracies, and I think that there needs to be a concerted effort to go through these various citations to confirm that they support what has been written.

I also added info from the OMIM database to the Genetics section. I really do not know why this was not added sooner. When genetics is discussed in such a way that it fails to cite one of the leading databases on genetic diseases, fails to mention that this disorder is listed in this database, and fails to mention that this database lists dozens of studies involving several different genetic loci....well, when these things are omitted, even though it's listed at the top of the main ADHD page and has been for a long time, it gives the impression that this article exists solely to support a certain POV.

More cleanup is definitely needed for this article. As it stands, the article appears to be written to support a specific POV, rather than to discuss areas where controversy exists. There are problems with factual accuracy, verifiability, reliable sources, omission of relevant information...the list goes on. Much of what is written here appears to be information removed from the main article due to POV, WP:UNDUE, and other reasons. This article should not exist solely for the purpose of giving a platform for critics who disagree with the conclusions of mainstream medicine. It can certainly be used to document claimss that have been published, but those claims cannot simply be put forth uncritically....or worse, misquoted from the original source.

Honestly, it feels like the title of this article could better be titled "All the crap Wikipedia wouldn't let us put in the main ADHD page." If you want to prove me wrong, then clean it up, check the sources, and present the material in an encyclopedic manner ~ Hyperion35 (talk) 19:07, 23 September 2009 (UTC)

The edits you describe as far as I can recall were not additions by me. With regard to teachers, they do not diagnose but there is controversy over them referring children for diagnosis. A number of state governments in the USA passed laws against this. I have not checked out your edits yet.--Literaturegeek | T@1k? 00:58, 24 September 2009 (UTC)

Re: teachers. Through the years we interact with hundreds, usually thousands, of children and parents. The staff (including administration and assistents) of any elementary school I've worked at can name the kids who have the diagnosis just because of pushy parents or pre-school teachers and the kids who should have the diagnosis, but don't. I don't doubt that we'd be right 95% of the time (and doctors don't have a better record than that IMO). Teachers don't, thank goodness, have the responsibility to give the diagnosis but we are, rightfully, listened to. In some cases, I don't doubt that a teacher's input is actually the only input.

Re: Norwegian. I added that paragraph, thinking that, when possible, information from outside the English-speaking world should be added to articles. I can translate any source in either of the Norwegian languages, if needed. I can usually verify information in Danish and Swedish sources as well, but cannot write in those languages. - Hordaland (talk) 10:58, 24 September 2009 (UTC)

Just because a source uses the word "Controversy"....

It is always useful to read through a source thoroughly to see what conclusions are drawn. The NICE clinical guidelines are referenced as claiming that there is "controversy" regarding ADHD, but if one reads through their findings, they examine and largely discard much of the supposedly controversial claims. Specifically, they note that much of the controversial claims offer little of practical value for clinical applications.

There is far too much to do justice with a short summary here. Additionally, much of this also applies to many other papers, reviews, studies, etc. where the word "controversy" may appear in a summary or introduction. There are many reasons why a source may mention "controversy" in its introduction. Probably the most obvious is because any paper that begins with "the scientific evidence in this field is fairly clear, and while we have nothing new to add, we needed to justify this use of grant money" is not likely to get published. Often a paper may begin by stating that there is controversy in the issue that they wish to examine, so as to raise questions that they will then answer. This is no different than an experiment establishing a null hypothesis. Just as the use of a null hypothesis does not constitute endorsement or even validity for that null hypothesis, it would be inappropriate to claim that the mention of controversy in the introduction of a paper is evidence for actual controversy.

With the NICE guidelines specifically, controversy is mentioned, but when one gets to the summaries in chapter 5, they again mention controversies, discuss evidence, and come to various conclusions (there are several different areas examined) that the review of the scientific evidence supports the validity of the diagnosis, the findings of genetic correlation, etc. The ironic result is that citing the NICE report to claim that those claiming controversy are not "fringe" is that the NICE report's conclusions actually tend to support the view that those who claim that the disorder is "controversial" are far outside of the mainstream scientific establishment. Here's NICE's own description:

"Here some of the issues that were raised, and the areas of controversy arising from differences in the perceptions of the speakers at the consensus conference, are discussed. Some of the complex areas of controversy relate to broader sociological and philosophical issues representing two conceptual paradigms, broadly characterised as medical–scientific and social–scientific. The latter perspective casts doubts on the utility and legitimacy of ADHD as a diagnostic category by emphasis on: the problematic nature of the meaning of ADHD, the social determinants of the behaviours that come to be labelled as ADHD, and the spectrum of human behaviour that results in indistinct boundaries of many medical diagnostic categories. While it is important to acknowledge the validity of the social scientific paradigm and its body of literature, in the context of the development of practical clinical guidelines, it is not possible to offer alternative processes for clinical assessment or treatment. It is accepted that the research literature reflects the dominant medical scientific paradigm and hence the nature of the evidence base."

Translation: Much of the "controversy" involves "alternative" social and philosophical views of clinical practice. That is to say that it is outside of the mainstream. And just to make sure that the readers have no doubt as to what they mean by this, they go on to state in the next paragraph:

"The evidence presented at the consensus conference indicated that there was a high degree of unanimity about there being a group of people who could be seen as having distinct and impairing difficulties and who should trigger the use of this guideline."

They go on to discuss the fact that there are legitimate differences between DSM and ICD diagnostic criteria, and the practical clinical implications of the use of each set of criteria. However, these passages, and the overall set of conclusions reached in the NICE paper quite clearly imply that "controversial" opinions represent a fringe viewpoint. If there is a high degree of unanimity, if there is a "dominant medical scientific paradigm," and if it is such that they can reach fairly certain conclusions, it follows that competing opinions are likely to fall into the category of "fringe" views. It is difficult to quote them as explicitly stating that such views are "fringe" only because they are not concerned with identifying and labelling "fringe" opinions, but rather they are attempting to sort the wheat from the chaff, as it were, with regards to what the current scientific consensus is.

So again, it is important to read through these papers. Even though they may mention the word "controversy" in the introduction, it is important to study their conclusions to determine whether these controversies represent legitimate conflicting evidence, or whether it involves a dichotomy between a dominant, unanimous, near-universally accepted scientific body of evidence contrasted with a few fringe claims that are worth mentioning but otherwise have little to offer from a scientific and/or clinical perspective.

If we are going to have a page like this, documenting areas of "controversy," then it is important that we accurately reflect the conclusions of medical scientific bodies that have reviewed the evidence available, and sometimes this will mean that we have to call a spade a spade and note where certain viewpoints are undeniably fringe viewpoints. Just because a review mentions that there is "controversy" does not mean that such "controversy" actually reflects legitimate scientific disagreement. ~ Hyperion35 (talk) 14:55, 25 September 2009 (UTC)

Hyperion, at first look this edit looks good.[11] This is what we do to add "balance" and "context". So good job with that edit.

We must stick closely to what refs say. Reinterpreting refs and drawing your own conclusions is original research however, you are reading statements and saying "they mean it is fringe", but they don't say that or use the word.--Literaturegeek | T@1k? 15:14, 25 September 2009 (UTC)

They do not use the word "fringe," but they describe the "controversial" viewpoints in such a way that it would fit the guidelines of WP:FRINGE. Specifically, for the purposes of a Wikipedia article:

"We use the term fringe theory in a very broad sense to describe ideas that depart significantly from the prevailing or mainstream view in its particular field of study."

So here we have a source stating that many of the allegations of "controversy" over ADHD depart significantly from the mainstream view. They go on to review the evidence presented and give a summary of their conclusions regarding the mainstream scientific view. Thus, this source actually confirms that much of the "controversy" involves viewpoints that are not reflected in the mainstream scientific evidence. As per WP:FRINGE, it is entirely appropriate to label such views as being fringe viewpoints, even where the source itself may not use that term. ~ Hyperion35 (talk) 15:31, 25 September 2009 (UTC)

Fringe theory

"8 percent stated that they did not regard ADHD as a real disease or disorder" That would, be um, fringe. As in, 92% think it's a valid diagnosis. Which would make it a view that is far from mainstream. Paranormal Skeptic (talk) 16:46, 24 September 2009 (UTC)

No that is a minority viewpoint. The encylopedia Britanica states that it is a minority.[12] Stated in the same article it says "The British Psychological Society suggested in a 1997 report that physicians and psychiatrists should not follow the American example of applying medical labels to such a wide variety of attention-related disorders: “The idea that children who don’t attend or who don’t sit still in school have a mental disorder is not entertained by most British clinicians.”" Do you have a reference which backs up your statement that it is fringe? If not then it is original research.--Literaturegeek | T@1k? 17:35, 24 September 2009 (UTC)

Did you look at the policy on what is a fringe theory? Paranormal Skeptic (talk) 17:40, 24 September 2009 (UTC)

As an aside, not looking for confrontation either. Just building a good encyclopedia :) In fact, I'm going to step off the article for a couple of days. Bad day at work, and not in the best of moods. Paranormal Skeptic (talk) 17:46, 24 September 2009 (UTC)

I did skim over the fringe earlier, but now have read it entirely. I can see nowhere in it which would state that if 8% of doctors believe X then they are "fringe". On the contrary the wp:fringe says "ideas should not be portrayed as rejected or labeled with pejoratives such as pseudoscience unless such claims can be documented in reliable sources." By labeling a significant minority of doctors as being "fringe" is adding in a judgement call, in my opinion an original research judgement and is not WP:NPOV. I have provided a source which says specifically "a minority" so why not write that in the article like the wp:fringe says that we should do? Editing articles in a bad mood is not a good idea! I know from experience! ;)--Literaturegeek | T@1k? 17:59, 24 September 2009 (UTC)

LG, the British Psychological Association quote cannot be found outside of Britannica. More importantly, it is directly contradicted by the 2009 ADHD Diagnosis and Treatment Guidelines issued by the British Psychological Society and Royal Society of Psychiatry, commissioned by NICE. That document quite clearly states that the idea IS entertained by a majority of British clinicians. At best, what you have is an outdated quote that is difficult to source correctly. Britannica is unclear as to whether the quote comes directly from the source or from commentary on the source, and in any event, the quote cannot be found anywhere on the BPS website.

Further, with regards to the BMJ survey, it is not even clear that all of the respondents were physicians, so I'm not sure that even claiming at 8% of physicians hold that view is correct. It doesn't strike me as a very scientific survey, nor is it clear that there is any meaning to the results beyond basic philosophical mental masturbation. Seriously, it strikes me as the sort of thing that researchers with too much time on their hands dreamed up to settle a bar bet. Obesity, Hypercholesterolaemia, and Menopause all received more votes than ADHD, as did. Go put the results of the survey on those wikipedia pages, see what the reaction is. I really don't think that this survey even meets basic statistical best practices, much less any sort of validity. All it does is demonstrate that if you ask 500 readers of BMJ a badly-phrased question, you'll get a lot of ridiculous answers. Here's a good rule of them when looking at surveys: If the results don't include P values, or Chi-squared, or any sort of regression or other statistical methodology, it's probably not worth the paper it's printed on. If an undergrad would have had it returned by a professor with "see me after class" written on it, then it probably doesn't belong sourced on Wikipedia. ~ Hyperion35 (talk) 10:34, 25 September 2009 (UTC)

And as to the question of deciding "fringe," a better determinant is the viewpoint of the mainstream medical societies. If a view departs significantly from that of the official positions of, for example, the AMA, APA, NIH, the BPS/RSP/NICE guidelines, etc, then "fringe" is probably a good description. A minority view would find itself mentioned within those guidelines, or would receive some support there...for example, behavioral therapy. A fringe view would be one that simply does not find any support within mainstream medicine. ~ Hyperion35 (talk) 10:49, 25 September 2009 (UTC)

So what are you saying, your originaal research argument is that the encylopedia Britanica is a book of invented lies about British institutions? I NEVER denied that "the majority" accept it as valid. I myself accept it as a verifiable disorder. Ok, well my stance is that I am tired of original research POV arguing back and forth. Please find a source which states fringe, otherwise minority views can't be labeled as such. If this continues much longer I am going to have to add you to arbcom and we will work things out from there. Actually the non-existance of ADHD is mentioned in the National Institute of Clinical Excellence as well as Britanica so by your own definition criticism is "minority" and not fringe.--Literaturegeek | T@1k? 11:18, 25 September 2009 (UTC)

Ok, NICE state that "many" people criticise ADHD. So the debate is over I think. Page 23 under controversies of the diagnosis. They also acknowledge that some reject the existance of the disorder. It can't be fringe if NICE acknowledge it according to WP:FRINGE.--Literaturegeek | T@1k? 11:57, 25 September 2009 (UTC)

The physics journals will also acknowledge the "Young Universe" theory, even though it's considered fringe. Biologist will acknowledge intelligent design, even though it's fringe. Lots of theories get published. What's fringe is whatever is out of the mainstream. Here's an example, take a look at the Ian Stevenson article. His theories on reincarnation were published, and acknowledged in his field, with very good support. However, his work is still considered fringe. Which in and of itself is not pejorative. At one point, heliocentrism was considered fringe. Paranormal Skeptic (talk) 12:33, 25 September 2009 (UTC)

Ok but you have not addressed the point that NICE says many, so you are comparing apples and oranges. You are challenging a statement with original research. Do you have a high quality secondary source to challenge the statement "many"?--Literaturegeek | T@1k? 12:39, 25 September 2009 (UTC)

Please don't reply with original research/personal opinion but with references.--Literaturegeek | T@1k? 12:47, 25 September 2009 (UTC)

It is rather difficult to "reference" a complete lack of support for a given view. That is rather akin to proving a negative. "Many" is also a bit of a weasel word there. Who are these "many?" What have they published? Where is the published evidence showing controversy? And I do not mean published evidence that says "many people find this controversial" but rather published evidence to contradict the statements that there is little controversy aside from the lack of long term studies on medication and the differences between DSM and ICD diagnostic criteria. What sources do you have that contradict the AMA's statement that "(d)iagnostic criteria for ADHD are based on extensive empirical research and, if applied appropriately, lead to the diagnosis of a syndrome with high interrater reliability, good face validity, and high predictability of course and medication responsiveness."

What sources do you have that contradict the 2007 review that found little variation in the prevalence of ADHD in North America and Europe, and found a prevalence of roughly 5.3%?

What sources do you have that contradict Barkley's 2002 Consensus Statement to the effect that there was very little controversy whatsoever regarding ADHD? Or to contradict the NIH Consensus Statement that the sole controversy was over long-term studies of the medications? For someone who asks for sources, you've been a bit reticent yourself. ~ Hyperion35 (talk) 13:21, 25 September 2009 (UTC)

And bear in mind that all of this still has to account for the evidence from neuroimaging showing distinct neurological differences. The 2005 review of the literature in that regard seemed to conclude fairly well that there were significant differences in specific regions of the brain that are well known to be involved in various executive function tasks where persons with ADHD have deficits. So again, I am still trying to figure out how any "controversies" can be viewed as anything but fringe. What citations do you have to people who actually claim to contradict established scientific evidence? The only legitimate sources that I have seen from either you or DocJames simply state "there is controversy" without actually discussing what is controversial. The closest is the NIH Consensus Statement that merely notes the lack of long-term studies on medications. ~ Hyperion35 (talk) 13:26, 25 September 2009 (UTC)

However, since you have demanded a secondary review of the literature which specifically and explicitly states that ADHD is not controversial, I will once again quote from the Consensus Statement written by Dr. Barkley, published in Clinical Child and Family Psychology Review and signed by many of the foremost experts in the field. In it, Dr. Barkley states categorically that "Among scientists who have devoted years, if not entire careers, to the study of this disorder there is no controversy regarding its existence."

I have mentioned this to you before, you have generally ignored it. The statement is signed by Zametkin, Biederman, Faraone, and many many many other leading researchers in the field. It is extensively cited, it constitutes a secondary source and it is probably the most exhaustive review of the literature that you will find. ~ Hyperion35 (talk) 13:51, 25 September 2009 (UTC)

If I can direct you two to the article, I've added two references covering the fringe theories involved in the causation of ADHD. Paranormal Skeptic (talk) 13:46, 25 September 2009 (UTC)

I searched the two books on google using keyword fringe, no results found.--Literaturegeek | T@1k? 15:20, 25 September 2009 (UTC)

As per LiteratureGeek's request at the top of her talk page, I have taken this discussion over to the talk page for the ADHD Controversies. I would however like to leave a small reminder for LiteratureGeek to please be sure to read through a source's summary and conclusions (as with the NICE guidelines), rather than simply citing the introduction alone. I am concerned that you may be drawing conclusions based upon a cursory reading, and that this may result in edits that do not accurately reflect the conclusions drawn by these sources. When other editors question the conclusions that you draw from a source, please consider that we may also have read through that source and many others, and that we may be trying to draw your attention to information that you may have overlooked. In short, before making accusations of OR, or threatening ArbCom, first Assume Clue. Thank you. ~ Hyperion35 (talk) 15:17, 25 September 2009 (UTC)

I am happy with your edit which put the controversy about ADHD itself into context. There is something like 100 pages in NICE review so will take time to read it all.--Literaturegeek | T@1k? 15:26, 25 September 2009 (UTC)

Section on Financial conflicts of interest

About CHADD it says "Children and Adults with Attention-Deficit/Hyperactivity Disorder, CHADD, an ADHD advocacy group based in Landover, MD received a total of $1,169,000 in 2007 from pharmaceutical companies. These donations made up 26 percent of their budget.". But the source says "Total pharmaceutical donation support of CHADD as of June 30, 2007 was 26.11% of CHADD’s budget ($1,169,000)".

To me(please note that English is not my "mothertounge")the claim on wikipedia is not back up by the source. The source seems to indicate that they recieve pharmaceutical support, not necesserly that the support is from pharmaceutical companies. The fraising in this articel is very suspisious. Therefor I remove this line until this meaning is clairified. —Preceding unsigned comment added by 192.71.219.1 (talk) 09:52, 11 July 2010 (UTC)

I do not see what is unclear about this? Doc James (talk · contribs · email) 10:37, 11 July 2010 (UTC)

Just like you I am a non-native English speaker, but the only way I can interpret "pharmaceutical support" is by "support from pharmaceutical companies". In which other way do you interpret this? Lova Falk talk 16:11, 11 July 2010 (UTC)

I read the .pdf from CHADD more carefully today. I thought that "pharmaceutical support" might mean pharmaceutical(medical) support and not necisserly as pharmaceutical(company) (monetary)support. —Preceding unsigned comment added by 85.224.168.108 (talk) 16:40, 12 July 2010 (UTC)

Relevance of links

Quote: "despite being a well validated clinical diagnosis.[7]" Well, [7] concerns "legal and ethical aspects", it says nothing about clinical validation /symptoms, testing and approval of their presence/, therefore it doesn't approve it. My conclusion - NO validation of this diagnosis. —Preceding unsigned comment added by Q2 (talk • contribs) 08:49, 22 July 2010 (UTC)

Revert of this: [13]

Saying that it's "relevant, properly sourced, not overstated, and certainly not deserving of the 'weasel' tag" doesn't make it so. Support your words.

Frequency of stimulant use

• Says nothing about the frequency of stimulant use.
• Is not self-evidently relevant. How does the fact that the United States uses the most stimulants have any bearing on controversies? The section should say. "Frequency of use" is not a controversy (at least, not as presented in the section), and should not have its own section anyway.
• The number is scary, but, again, there's nothing to say how it matters. It just IMPLIES something bad. That's subtle bias.

Concerns about side effects and long term effectiveness

• "Studies have shown that stimulants offer no benefits over behavioral management for periods over 3 years."

So yeah, those studies. Those studies "have shown" that there's no benefit? How do you "show" that something has no benefit? I changed it to "have suggested"; why was this reverted?

• Also, someone left a concern in the comments that a source does not support what cites it. Someone should check the rest of that.

--146.96.130.201 (talk) 15:18, 8 September 2010 (UTC)

• This is a statement that I restored: "In the 1990s the United States used 90% of the stimulants produced globally, in the 2000s this has decreased to 80% due to increased use in other areas of the world." The statement is backed up by a reliable source. What is your objection? Do you not consider it a reliable source? Do you doubt the percentages that are provided by the source? I fail to see any reason this should have been removed.
• "Some parents and professionals have raised questions about the side effects of drugs and their long term use": Again, backed up by a source. No weasel words. It's a statement of fact.
• "Studies have shown that stimulants offer no benefits over behavioral management for periods over 3 years.": Backed up by a source. No weasel words.
• "Other side effects of concern include addiction, growth retardation, suicidal thoughts and effects on the heart. This has led to interest in non-drug treatments such as omega-3 oils which can help symptoms of ADHD.": Backed up by a source. No weasel words.
• You say, "It just IMPLIES something bad. That's subtle bias." I have no idea what point you're trying to make here, so you're going to have to explain how providing reliably sourced statistics is intended to be "scary", "implies something bad", or is a "subtle bias". Your comments make no sense.
• How do you show that a drug has no benefit COMPARED TO behavioral treatment? That's fundamental science. You have a group that receives the drug, and a group that receives behavior management. After the treatments, if the drug group shows no significant improvement COMPARED TO the behavior management group on relevant behavioral measures, the conclusion is that the drug "offer no benefits over behavioral management". That's covered in Scientific Method 101. Read Scientific method and related links.
• You say, "someone left a concern in the comments that a source does not support what cites it. Someone should check the rest of that.": I'm not sure who the vague "someones" are here, but I have read the sources and there is no problem. If you think there is, read the sources and give up specifics on this talk page. Cresix (talk) 22:58, 8 September 2010 (UTC)

• My objection is that there's nothing saying that it has anything to do with "concerns". A relevant statement would be, "So-and-so organization have expressed concerns about the prevalence of stimulant usage in the United States versus other countries, citing that 90% blah blah blah." The whole section has a misleading section header, and keep in mind that its parent section is "Concerns about medication".

Your comment is quite unclear, but you mention the header. The header is "Frequency of stimulant use" and the text is about frequency of stimulant use. I don't see a problem. Cresix (talk) 17:23, 12 September 2010 (UTC)

My objection is that there's nothing saying that it has anything to do with "concerns". A relevant statement would be, "So-and-so organization have expressed concerns about the prevalence of stimulant usage in the United States versus other countries, citing that 90% blah blah blah." The whole section has a misleading section header, and keep in mind that its parent section is "Concerns about medication".

Feel free to find the sources and add. That's much more appropriate than wholesale removal of sourced and accurate information. Cresix (talk) 17:06, 13 September 2010 (UTC)

Also, "frequency" is "x per time". "90% of stimulants"... what does that have to do with frequency of usage? --68.161.172.2 (talk) 06:49, 13 September 2010 (UTC)

• I'll back off on the weasel words accusation.

Well done. Cresix (talk) 17:23, 12 September 2010 (UTC)

Patronization is hardly becoming of a Wikipedia editor. A little something called Wikiquette. --68.161.172.2 (talk) 06:49, 13 September 2010 (UTC)

Hypersensitivity and false inneuendo are not becoming of a Wikipedia editor either. A little something called Wikiquette. Cresix (talk) 17:06, 13 September 2010 (UTC)

• You really don't see how statistics placed in a certain context can make implications?

Of course I do. I've conducted dozens of studies using a vast range of statistics. But you have provided absolutely zero support for such an accusation here. Cresix (talk) 17:23, 12 September 2010 (UTC)

I'll state it outright then. It's implying:

• There is "too much" of it being used in the United States.

Find good sources and add that, but please conform to WP:WEIGHT. Cresix (talk) 17:06, 13 September 2010 (UTC)

As it stands, it's just a statistic. It's not SAYING anything about controversy, which is what the section is about. Find someone who actually says, "There is too much stimulant usage by children diagnosed with ADHD in the United States." Statistics in an article need to support some statement, or claim, within the article. What does this statistic support? --68.161.172.2 (talk) 06:49, 13 September 2010 (UTC)

The statistics support the facts that they describe. If you want something about "too much stimulant use", you find sources and add according to WP:WEIGHT. Again, that's much better than wholesale removal of accurate and sourced information. Cresix (talk) 17:06, 13 September 2010 (UTC)

• You misconstrue my objection. "Benefit" implies ANY benefit, rather than just the intended effect. If the studies show that there's an improvement in behavior in one group over the other, then the wording should be clarified. How do you prove that one treatment has NO benefits? They would have to measure general health, happiness, relationships, and an uncountable number of other possibilities. I highly doubt that they've made such a claim.

Have you actually read the research, or are you simply jumping to conclusions based on what you think the research is about? "Benefit" refers to reduction in measurable ADHD symptoms. What other other benefit do you suggest? The wording does not need to be clarified; this is an encyclopedia, not a journal article. An encyclopedia summarizes much more extensive information. Every detail of every study does not need to be described. If the information is from peer reviewed journals, the assumption is that the results are valid unless someone can provide evidence to the contrary. Cresix (talk) 17:23, 12 September 2010 (UTC)

I added a few words of clarification. Now, I hope that puts to rest this rather overblown objection. Cresix (talk) 17:59, 12 September 2010 (UTC)

"Benefits": You mean besides the possible benefits that I've already suggested? Well, less negative side effects, less extreme side effects, and less possibility of suicide are all things that I think are commonly considered medical benefits. I don't see how you can argue against this. Did the study go through each and every one of them, and much more? I don't need to read the article to know that it's impossible for them to have done so. Peer-reviewed articles tend to be more precise. (By the way, the second ref for it [14], and the second time the second ref was used, actually said that there was an improvement in behavior according to parent/teacher ratings. Totally not "no benefits", or even "no ADHD-related benefits".)

The studies, and the statements in Wikipedia, are concerned with reduction in ADHD symptoms. Side effect issues are discussed elsewhere. Every study does not need to go through every issue related to every controversy. That's absurd. Cresix (talk) 17:06, 13 September 2010 (UTC)

"Shown": A few studies is a "suggests" more than it is a "shows". The second article itself says that more research is needed. --68.161.172.2 (talk) 06:49, 13 September 2010 (UTC)

• As for the scientific method, don't patronize me about science while at the same time claiming that a few experiments can be proof of a very vast claim. One of the principles of science is that you can't prove anything. This is especially true once you involve people and statistics, and even more so when it's psychology. There, it's not easy to prove something even beyond a reasonable doubt.

No one has used the word "prove". Give me quote from the article or from the sources in which the authors argue that something has been "proven". You set up a straw man to attack with absolutely no foundation. The results are reasonably stated based on the study results. If you make a statement that shows a blatant disregard for the scientific method, I have no choice but to challenge it. This is a medical article based on scientific research. It's not a playground for you to make outlandish statements that are contrary to the sources for the article. Cresix (talk) 17:23, 12 September 2010 (UTC)

"Shown" is a synonym for "proven" in the context of the sciences. If you disagree, well, replace all instances of "prove" with "show" and stop nitpicking.

First, you are simply wrong. "Shown" is not a synonym for "proven", especially in scientific research. Read a few journal articles. A study can say that Group A was shown to score higher on the WISC-IV than Group B; that's not the same as saying that Group A is proven to be smarter than Group B. Again, you create a straw man to attack that is baseless. Cresix (talk) 17:06, 13 September 2010 (UTC)

This has nothing to do with the scientific method. The scientific method simply gives you the steps to either disprove a hypothesis or fail to disprove it. It has to do with the specific wording of the article making a broad claim that no peer-reviewed article would make (i.e. "shown to have no benefits").

It has everything to do with the scientific method. If a well controlled study shows that Group A and Group B are statistically identical on measures of benefits 1, 2, and 3, then the study has shown that the groups are not different on the measured outcomes. One more time: Every study is not required to investigate every disputed issue. A study focuses on specific issues and reports on those specific issues. Give me example in which the sources cited reach conclusions about issues that were not studied. Your argument is utterly confusing. Cresix (talk) 17:06, 13 September 2010 (UTC)

I've given you no reason to assume that I'm ignorant of the tenets of science, except that I'm disagreeing with you. Stop insulting me and make your points with your points. --68.161.172.2 (talk) 06:49, 13 September 2010 (UTC)

Then please stop making wild and false claims that suggest either lack of knowledge or completely ignoring the scientific research on ADHD for the past 20 years. And you please stop insulting my understanding of the scientific method, behavioral research, and an actual knowledge that comes from actually reading the studies rather than assuming things about them. Cresix (talk) 17:06, 13 September 2010 (UTC)

• The "someones" aren't a mystery person. There's an HTML comment: "Neither safety nor efficacy of stimulants has been determined beyond two years on following ref." I haven't checked on the ref myself, but it should be checked. --74.73.95.226 (talk) 16:10, 12 September 2010 (UTC)

Let me repeat myself. I have read the sources. There is no problem. If you haven't read the sources, by all means please read them and tell us what the problems are. Cresix (talk) 17:23, 12 September 2010 (UTC)

Let me clarify: it should be checked by someone who isn't currently involved in this discussion, free of a need to win an argument. --68.161.172.2 (talk) 06:49, 13 September 2010 (UTC)

I don't have a problem with that. That, of course, rules out you and me and anyone else who has been a major contributor to the article. If someone checks, I trust they'll let us know what they find. Until then, however, please don't make a mountain out of a molehill. Cresix (talk) 17:06, 13 September 2010 (UTC)

Ref-check

The second ref says that there was only ONE study, and that it wasn't a randomized controlled trial. And the study it cites is the other ref. What are the rest of the "studies"? This isn't giving me much confidence in the ref-checking for this article.

At 3 years post-randomization the percentage of children taking medication >50% of the time was: behavioural 45%; stimulant 72%; combined 70%; and usual care 62%. Five outcomes that were previously statistically different or particularly clinical relevant were measured at 3 years. There were no significant differences between therapy groups for any of these 5 outcomes. Furthermore, the proportion of children meeting the diagnostic criteria for ADHD had dropped to about 50% and was not different between the 4 therapy groups.

— http://www.ti.ubc.ca/letter69

I'm honestly not certain what it's saying, but it seems to me that there's no difference between ANY of the treatment options, including combined and usual care (i.e. random kids who mostly got stimulants as represented by the norm). And many of them started taking stimulants anyway (45% for the behavioral group, who I assume started out not taking drugs). The refs never state anything like "no benefit between behavioral and drug care", and in fact doesn't try to explain the discrepancy as such. And the WP page ignores that there's no difference between combined and behavioral, either, leaving out important information for the reader that could give them a different view of the results.

This is definitely a problem. --68.161.172.2 (talk) 07:10, 13 September 2010 (UTC)

Without getting into the details of any study, what happened to your idea that the ref checking must be done by "someone who isn't currently involved in this discussion, free of a need to win an argument." Did you suddenly develop total amnesia and forget that you are involved in the above arguments? Cresix (talk) 17:06, 13 September 2010 (UTC)

BTW, I'm not sure what you are reading into (or failing to read into) the Jensen study and the Therapeutics Letter, but here are the essential findings as reported by each:

Jensen study: "treatment groups did not differ significantly on any measure at 36 months"

Therapeutics Letter: "At 3 years post-randomization ... there were no significant differences between therapy groups for any of these 5 outcomes"

The two report the exact, same finding (which is to be expected because the TL source is reporting on the Jensen study). No difference in ADHD symptoms measured after three years. I don't see the problem. The words don't have to be word-for-word identical to state the same conclusion. But since you have declared me an unfit interpreter of the findings (and I have declared you equally unfit), we must see what someone else says. So until then, as I said above, stop making a mountain out of a molehill. Cresix (talk) 01:25, 14 September 2010 (UTC)

I was pointing out why there needs to be someone else checking, because I'm clearly reading something different from what you're reading. Just because I checked it myself doesn't mean I still think there's a need for someone else to check it. Thanks for being petty.

My point was that saying "There's no benefit of A over B" when listing reasons why drugs are bad gives very different connotations than (what was actually said) "There's no significant difference between A and B, nor C, D, and E." --68.161.150.98 (talk) 15:39, 15 October 2010 (UTC)

Listed on Wikipedia:Third opinion. --68.161.150.98 (talk) 15:43, 15 October 2010 (UTC)

Scientifically, statistically, and logically, stating that "There's no [demonstrated] benefit of A over B" (my clarification in italics) is equivalent to saying "There's no significant difference between A and B". To state that A or B has benefit over the other requires a statistically significant difference. That's a fact that virtually anyone with an undergraduate degree in a science knows. Cresix (talk) 16:20, 15 October 2010 (UTC)

Agreed. It also says nothing about A vs B vs untreated. htom (talk) 18:00, 15 October 2010 (UTC)

They're not the same thing. $A\leq B$ is obviously not the same thing as $A\sim B$. If the article had read, "Studies have shown that behavioral management offers no benefits over stimulants...", that would give the completely opposite connotation from the original statement, and puts behavioral management in a bad light. Especially since the section is basically about "Why do people think ADHD medication is bad?"

It's patronizing and disrespectful to once again imply that I don't understand science, when the main cause for you believing that is that I'm arguing with you. I'm not exactly flaunting my scientific certification to lend weight to my argument, so why do you feel the need to do differently? --67.243.1.227 (talk) 12:57, 21 October 2010 (UTC)

No one has said that $A\leq B$ is the same as $A\sim B$. And it's not patronizing for someone to say you are wrong when you are, in fact, wrong. I could claim that gremlins broke my car engine; it's not patronizing to tell me that, mechanically, that is wrong. You've made a weak attempt at creating a straw-man: "If I say anything you disagree with, I'm always right and you're always wrong. Don't patronize me by telling me I'm wrong." It is accepted by every science that "There's no demonstrated benefit of A over B" is equivalent to saying "There's no significant difference between A and B". That's not patronizing you, no matter how much you complain that it is. It's a fact. It doesn't matter whether you say "behavioral management offers no benefits over stimulants" or "stimulant use offers no benefits over behavioral management"; neither of those statements puts one or the other treatment "in a bad light"; it simply says that neither has been shown to be better than the other. As for the title of the section, as I'm writing this the title is not "Why do people think ADHD medication is bad?"; it's "Concerns about side effects and long term effectiveness". I have concerns about giving children immunizations for tetanus because of the extremely remote chance the child can have a seizure. That is not the same as saying that "Immunizations are bad".

Let's see if anyone agrees with you on that point because, so far, no one has. Now, I don't intend to go back and forth with you endlessly by repeating the same thing over and over. You can rant to your heart's content about your scientific expertise and being patronized, just don't make changes to the article on these issues without consensus, and there is no such thing as a consensus of one. Unless there are other opinions expressed on this matter I'm finished with this exchange with you. Cresix (talk) 15:15, 21 October 2010 (UTC)

Going to cut it down to one point, so that you can't ignore it again.

If the article had read, "Studies have shown that behavioral management offers no benefits over stimulants...", that would give the completely opposite connotation from the original statement, and puts behavioral management in a bad light.

We have:

1. "There's no demonstrated benefit of A over B"
2. "There's no demonstrated benefit of B over A"
3. "There's no significant difference between A and B"

If you claim otherwise, you are claiming that the first statement, since it's equivalent to the third, is also (by symmetry) equivalent to the second, and so the first and second statement are, according to you, equivalent. Do you agree or disagree? --68.161.150.135 (talk) 08:17, 22 October 2010 (UTC)

"If the article had read, "Studies have shown that behavioral management offers no benefits over stimulants...", that would give the completely opposite connotation from the original statement, and puts behavioral management in a bad light.": You are wrong (again).

"1. There's no demonstrated benefit of A over B"

"2. There's no demonstrated benefit of B over A"

"3. There's no significant difference between A and B"

All three statements are statistically equivalent, and none of the statements puts A or B "in a bad light". Do not change the article without consensus. End of discussion unless other editors express opinions. I have no obligation to repeat myself again and again to your repetition of the same argument over and over. In case you missed it: End of discussion between you and me. Cresix (talk) 15:13, 22 October 2010 (UTC)

• This isn't a statistics article written for statisticians. It should be written for the layman, and "no benefit of A over B" is "A is less than or equivalent to B".
• Even ignoring that, show me a source for how you can say something like this is "statistically equivalent". "Equivalent" means that they're interchangeable, and I find it hard to believe that statisticians use the three equivalently in a technical sense.
• I've edited the article three times, and only the first edit is related to this discussion. It's bad enough you act like you have superior knowledge of science and, I guess, statistics. Stop pretending I'm edit-warring with you. (And no, while you haven't said anything that would unambiguously accuse me, your unnecessary repetition imply (there's that word again) that I'm still editing the article.) --74.73.95.226 (talk) 08:18, 8 November 2010 (UTC)

Ugh, I probably have to prove to you that they're not equivalent in English.

1. Statement P := "A has no benefit over B".
2. Statement Q := "B has benefits over A".
3. Statement R := "A has benefits over B".
4. Statement S := "B has no benefits over A".

You claim that P and S are equivalent. But {P,Q} is consistent (i.e. having both statements presents no contradiction), and {R,S} is consistent, while {P,R} and {Q,S} are both inconsistent. How can a statement be equivalent to another statement if they have different sets of consistent statements? --74.73.95.226 (talk) 08:24, 8 November 2010 (UTC)

Already answered in full, several times. Discussion is finished between you and me; and, in fact, you can rant all you wish, this is my last message to you. I will respond if other editors comment here. Do not change the article without a consensus; there is no consensus at this time. Cresix (talk) 16:03, 8 November 2010 (UTC)

You can say that you've already said it all you want, but you still haven't, at all, addressed how your claim of equivalence is logically consistent. To reiterate: Show how {P,Q} is consistent and {S,Q} isn't if P=S. --68.161.152.132 (talk) 07:02, 6 December 2010 (UTC)

Already answered in full, several times. Discussion is finished between you and me; and, in fact, you can rant all you wish, this is my last message to you. I will respond if other editors comment here. Do not change the article without a consensus; there is no consensus at this time. Cresix (talk) 16:06, 6 December 2010 (UTC)

Your Third Opinion

Hi, I'm here to give your third opinion.

• Both sides should remember that the goal is to write a neutral encyclopedia article, not further one side of the debate.
• Some of 68.161.150.98's edits seem to be appropriate, removing POV statements that do not add much to the article. On the other hand, the large addition here amounts to an essay pushing the POV that ADHD can't be faked easily.
• It looks to me that the material that Cresix reverted to re-add that started this does have some weasel elements. It's weaselly to say "Studies have shown" when there have been other studies that contradict those studies. It implies a sort of scientific consensus where one clearly does not exist, since the mainstream view is that medication is an effective treatment for ADHD.
• As I alluded to, our article should reflect mainstream views when speaking in Wikipedia's voice. If a particular claim is controversial within credible sources, it needs to be specifically attributed to who said it. Since this article is a "controversy" fork, most of the statements in it should be specifically attributed to who said them, rather than written in the neutral voice. For example "Gigs, et al in a single-blind study of 30 children found that eating sweet-tarts was an effective treatment for ADHD. This result was replicated by Bob Russo in 1998." rather than "Studies have shown that sweet-tarts are just as effective at treating ADHD as stimulants"

Hope this helps. Gigs (talk) 14:14, 18 October 2010 (UTC)

I only made three edits to the article, from what I can see in the history. Only one (consecutive pair) was controversial, whereas the other was maintenance. I went to the talk page rather than reverted.

My issue is that I don't think the article IS being neutral, and using the source in a way that does not convey the intent of the study (i.e. saying that drugs aren't better than behavioral management when the source also says that behavioral management isn't better than drugs either). --67.243.1.227 (talk) 12:57, 21 October 2010 (UTC)

Out of date ref and cited improperly to make an incorrect and uncited statement.

The reference listed for "However, methylphenidate, the most commonly used pharmacological treatment for ADHD has not been evaluated in controlled clinical trials for longer than 4 weeks." Is extremely out of date (10 years) and cited incorrectly. The article states that "Moreover, we were unable to demonstrate that the methylphenidate effect is maintained beyond 4 weeks" meaning that this specific study, did not include any studies in their meta-analysis that had placebo-controlled studies lasting longer than 4 weeks.

This SAME EXACT PAPER goes on to state "The recently completed MTA trial,68 though lacking a placebo group, may address some of the concerns identified in this meta-analysis regarding long-term treatment. It was methodologically sound and had sufficient power to detect the superiority of medical management (with 73.4% of participants maintained on methylphenidate at study end) over a relatively long-term period (i.e., 14 months) in a comprehensively assessed patient population." (http://archpsyc.ama-assn.org/cgi/content/full/56/12/1073?ijkey=007cc629e52685a2458e29978adfe35259d2f48e)

While lacking a traditional controlled placebo the study does contain "A group of 579 children with ADHD Combined Type, aged 7 to 9.9 years, were assigned to 14 months of medication management (titration followed by monthly visits); intensive behavioral treatment (parent, school, and child components, with therapist involvement gradually reduced over time); the two combined; or standard community care (treatments by community providers)."

It goes on to state that "For ADHD symptoms, our carefully crafted medication management was superior to behavioral treatment and to routine community care that included medication. Our combined treatment did not yield significantly greater benefits than medication management for core ADHD symptoms, but may have provided modest advantages for non-ADHD symptom and positive functioning outcomes."

I believe this give sufficient proof of long term efficacy. Since this 2nd article was already published at the time of the original, this wikipedia statement should never have been made (or at least stated in the way it is).

In the interest of not starting an edit war I'll leave AS IS for comments for a week then deleting.75.72.127.125 (talk) 05:27, 6 April 2011 (UTC)

Just simply based on the date of the study, I agree that sentence needs to go. If someone can cite more recent research on the efficacy of (or lack thereof) methylphenidate, that would be helpful. But the current source is sufficiently outdated (and not very conclusive) such that any statements in the Wikipedia article derived from it are not appropriate. Cresix (talk) 16:56, 6 April 2011 (UTC)

Move tag

Could the tagger please give some details of what is wanted and why. If the tagger intends to make the changes soon then we don't need many details. If it is to be left to someone else then a lot more information would be required. Op47 (talk) 20:43, 27 July 2012 (UTC)

The social science perspective

Recently, a paragraph was added about the social science perspective. I see many problems with this text. Here it comes, in pieces.

• The social science perspective challenges the biomedical view on the cause of ADHD symptoms. Symptoms are seen by this perspective as a consequence of normalisation; where it has been constructed in culture/society that it is normal to be focused/well-behaved/patient etc. and therefore abnormal to act differently.
  

The problem with this sentence: Google book search of the word ADHD in this book gives one result and doesn't cover this sentence. A search of the word normalization in this book gives a couple of more results but not in connection with ADHD or with being "focused/well-behaved/patient" etc.

• Ruth Benedict argues that in most modern cultures normal is associated strongly with being good, whereas abnormality usually carries bad connotations.

The problem with this sentence: Ruth Benedict's arguments are from 1934 and therefore say nothing about "modern" cultures or ADHD - diagnosis didn't exist yet

• These 'abnormal' symptoms have therefore succumbed to medicalization; where the tendency for abnormality is labelled as a disease (that requires treatment). Although some argue that the medicalization of what is constructed as socially detrimental behaviours would alleviate patients of responsibility for their actions, others insist that it merely permits health professionals to exert influence over the care and management of such individuals.

The problem with this sentence: A general text from 1972. Also not about ADHD.

• In addition, although medicalization may be liberating for some, it can be oppressive to others. Medicalization of ADHD and its biomedical treatment can lead to iatrogenesis (medical treatment-caused symptoms) and added complications for the individual.

The problem with this sentence: Google book search of the word ADHD in this book gives NO results.

• Therefore not only do social science perspectives challenge the validity of the 'disease' but they also highlight the negative social and medical aspects associated with treating the 'symptoms'.

The problem with this sentence: unsourced.

Please comment! Lova Falk talk 10:36, 6 May 2013 (UTC)

I agree that this is all problematic content. It should probably be deleted.--MrADHD | T@1k? 19:42, 6 May 2013 (UTC)

I have now deleted this text. Lova Falk talk 21:56, 22 May 2013 (UTC)

References

Women with ADHD

In the 'Over/under diagnosis' section, I feel more information on the issue of women's under-diagnosis is necessary. There has been quite a lot of research done on this controversy, and this article really downplays the significance of the underrepresentation of women with ADHD. Characterization of ADHD has been suggested to be more applicable to men, causing many women with ADHD to go undiagnosed. This has had serious consequences, as untreated ADHD women are prone to suicide and self-injury. PARossignol (talk) 00:05, 21 April 2014 (UTC)

 Done

Imaging and other pathophysiology

I'm surprised that no one has mentioned the extremely obvious bias in the imaging and other pathophysiology here and in the main ADHD article. Both fail to mention the fact that researchers conveniently (and gleefully in most cases) ignore the fundamental scientific fact that correlation does not imply causation and that any correlated pathophysiological finding may be effect rather than cause. In fact, there is STRONG scientific evidence that many of the chronic disorders of today triggered, if not in some cases completely caused by, ineffective sleep leading to downregulation by the amygdala of nonessential areas of the brain (prefrontal cortex, etc), and upregulating the hypothalamic-pituitary-adrenal axis, leading to chronically increased adrenalin, chronically increased cortisol, chronic dysregulation of grehlin and leptin, etc. See textbooks of pharmacology written by Stephen Stahl, et al. Jkhamlin (talk) 20:40, 23 July 2011 (UTC)

First, I don't think I've ever read a journal article that concluded any neurological/psychiatric disorder was "completely caused" by anything. At our present state of scientific knowledge, especially in an area as fantastically complex as the human brain, claiming to have found a single, smoking-gun source of all of our problems is going to make people skeptical. Especially without any sources that can be easily verified by other editors.

With that said, what is your suggestion here? You list those four hormones, only one of which has any proposed connection with ADHD, and implicate "ineffective sleep." It's certainly possible, even likely, that sleep issues have some bearing on the disorder, but please provide specifics. Drake144 (talk) 12:57, 24 July 2011 (UTC)

I'd also add that - neurological imaging has barely gotten out of its infancy. Part of how one develops an understanding of neurological mapping results, is by looking at POTENTIAL incidents of causation, and determining if they are actual causation, or simply correlation. I have never heard of a researcher in this field, "gleefully" ignoring those differences, and claiming causation regarding ANY imaging results which indicate possible neurological triggers/causes for ADHD. I have heard many people in this field, gleeful that they finally have begun developing the technology necessary, to be able to track issues neural pathway activity, so they can begin to do genuine scientific research on what results did show causation and what just showed correlation. But that is not the same thing.

In fact, the article currently says, "Frequently observed differences in the brain between ADHD and non-ADHD patients have been discovered, but it is uncertain if or how these differences give rise to the symptoms of ADHD. Results from various types of neuroimaging techniques suggest there are differences in the brain, such as thinner regions of the cortex, between individuals with and without ADHD." Uncertain, give rise, suggests - none of these are remotely definitive words, because the researchers cited are not claiming definitive results. They - as proper scientific research requires - state only that they've seen indications of neurological connections which require further study and evidence.

If you have sources showing evidence of this bias you're claiming, you should provide examples. CleverTitania (talk) 01:16, 4 June 2014 (UTC)

Fix

I went over the fringe science beliefs and edited some, to not give unfair weight to viewpoints held by the very small minority. Any questions, visit me on my talk page. ThePlatypusofDoom (talk) 19:58, 8 April 2016 (UTC)

Recent changes

@Lova Falk:, I am concerned about the large scale changes you have made to this article. You appear to have removed MEDRS compliant sources in your edits such as here here. Your edit summary seems to indicate you are removing any material that does not have a negative conclusion about medication side effect/effectiveness, which is creating a gross violation of WP:DUE by presenting only one side. While there are controversies in this area, we have to include the mainstream medical opinion on these matters (i.e. that methylphenidate is considered safe). You have also introduced poor medical sources such as old editorial or primary animal studies against WP:MEDRS. Yobol (talk) 19:11, 14 May 2014 (UTC)

Hi Yobol! Thank you for talking to me, and I understand why you are concerned. However, this is not the article ADHD, not Methylphenidate. This is an article about controversies around ADHD. The section is called: concerns about medication. So it should in a neutral way describe the concerns - rather than in a neutral way describe the long-term effects of the medication. Such a description belongs to Methylphenidate - where you can find it. With friendly regards! Lova Falk talk 19:38, 14 May 2014 (UTC)

And PS: It's night now in Sweden, and tomorrow I'll be at work, so it'll take some time before I can continue our discussion. Lova Falk talk 19:38, 14 May 2014 (UTC)

Well, a neutral description of the concerns has to include all relevant data about it, i.e. not just what the concern is, but what the medical mainstream opinion of the concern is, how relevant that concern is, etc. Otherwise, this isn't a neutral article, but a hit piece where critics' opinions go unopposed and our readers are intentionally left with only one viewpoint about a controversy. I can't see how that can be considered encyclopedic. Yobol (talk) 19:48, 14 May 2014 (UTC)

Yes, it would be best to conclude the discussion of each individual concern with a brief summary of the mainstream view. Primary sources should not generally be used, per WP:MEDRS. 94.196.239.217 (talk) 22:07, 14 May 2014 (UTC)

Hi Yobol and 94.196.239.217. In the present text in the section "Concerns about side effects and long term effectiveness" there are TWO sentences describing these concerns:

1) Some parents and professionals have raised questions about the side effects of drugs and their long term use.

2) On February 9, 2006, the U.S. Food and Drug Administration voted to recommend a "black-box" warning describing the cardiovascular risks of stimulant drugs used to treat ADHD.

The rest of the section are lots of assertions that these concerns are invalid. Now this is not a neutral section at all. Parents and researchers have serious concerns about side effects - this section does not even mention which side effects the drugs can have - not even the side effects that the pharmaceutical companies themselves mention on the leaflet that accompanies the drugs (at least in Sweden).

Furthermore, I would like to ask you: don't you think that a section about concerns ought to differ from a section about the medication? Parents who express their concerns usually do not write scientific articles like the ones described in WP:MEDRS - but does that mean that they should not be represented?

Today has been a tough day at work, I'll get back to you tomorrow or in the weekend. Lova Falk talk 19:09, 15 May 2014 (UTC)

As I stated before, a neutral article has to give the medical consensus on the safety of these medications. Certainly any notable controversies about side effects, if established and noted in reliable sources, can be discussed. However, you removed all mention of the medical consensus, which is inappropriate. Every medication has side effects; we are not here to document every single side effect, every single "concern" anyone in the world has ever had about medications. We are here to document, given due weight, notable controversies and concerns while documenting the medical consensus about the validity of those concerns. Yobol (talk) 19:27, 15 May 2014 (UTC)

I would like to clarify two points here. One is simply that parents having concerns is not really a relevant statement. Just a few years ago, a whole lot of parents were concerned about the risks of autism associated with vaccines, and it turned out that not a single one of their concerns was scientifically relevant - and even the 'researcher' who told them he did have evidence, made it up. Parent's concerns are only relevant, if you provide the scientific evidence which either supports or refutes (or both if both exists) their concerns.

Secondly - A single 15-person FDA Advisory COMMITTEE recommended a black-box warning - in an 8 to 7 vote. Not the FDA at large. After that, another pediatric FDA panel reviewed the information and did NOT advise a black-box warning, but simply an additional warning about a minimal increase in risk of cardiac issues. In 2007, the FDA specifically declined the first committee's recommendation, and did not issue a black-box warning. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3896970/

That second statement does not suggest the actual reality of the issue. There is no current black-box warning on ADHD medications, and there hasn't been one ever, to the best of my knowledge. The FDA as a group, has never decided the additional cardiovascular risk was prevalent enough to warrant it. CleverTitania (talk) 01:03, 4 June 2014 (UTC)

• I would like to respectfully draw everyone's attention to WP:PSCI. Some opinions and viewpoints must not be given equal weight. Care needs to be taken so that this article does not become a promotion for fringe and/or pseudo-scientific opinions that are contradicted by accepted science. -Ad Orientem (talk) 19:28, 7 April 2016 (UTC)

• I am concerned about the pro-Scientology stance of this article. I fixed some false claims, but they resurfaced again, and I removed them again. This gave undue weight to a minority opinion that is considered fringe science. I fixed the article, and I ask any future editors to not put any pseudoscientific material. ThePlatypusofDoom (talk) 16:41, 9 April 2016 (UTC)

Article Improvement

Just joined Wikipedia because of the appalling quality of the main ADHD article. This page should not even exist. Should be flagged for deletion immediately and if (BIG IF) any of this is worth mentioning, fold it into the main article. Saying that ADHD might not exist is on par with claiming that vaccines might cause autism. Citations are ancient and often misconstrued. I came here looking FOR the links to recent studies so no: I do not have the cites but some of this can be deleted outright. The line citing Snopes isn't even an accurate representation of the contents of the article. FlintHoldsFire (talk) 15:02, 2 March 2019 (UTC)

If I can direct you two to the article, I've added two references covering the fringe theories involved in the causation of ADHD. Paranormal Skeptic (talk) 13:47, 25 September 2009 (UTC)

I searched the two books on google using keyword fringe, no results found.--Literaturegeek | T@1k? 15:20, 25 September 2009 (UTC)

The reference does not say theories are fringe, says social critics and fringe religious groups, (eg scientology). It is self published source to a personal website of Dr Russell Barkley. Please see WP:MEDRS and also Wikipedia:Verifiability#Self-published_sources_.28online_and_paper.29. The use of this ref is questionable and certainly should not be in the lead. Also it is being misrepresented.--Literaturegeek | T@1k? 15:35, 25 September 2009 (UTC)

I have removed information added to this talk page that was taken from my user talk page by another user, as this makes the discussion a bit confusing. However, if you are referring to Barkley's consensus statement, that was published in a peer reviewed journal, I merely linked to the version stored on his website for ease of reference. It was not self-published, as you should have noticed. ~ Hyperion35 (talk) 15:38, 25 September 2009 (UTC)

Additionally, as I mentioned in an above section on this talk page, the important question is whether a reliable, verifiable source describes a particular viewpoint in such a way that it qualifies as a fringe viewpoint under WP:FRINGE guidelines. Specifically, the WP:FRINGE guidelines describe a fringe viewpoint as one that departs significantly from mainstream view in a particular field. Even if a source does not specifically use the term "fringe," we may still apply that label if the source describes a viewpoint in that manner. ~ Hyperion35 (talk) 15:47, 25 September 2009 (UTC)

The theories of ADHD not even existing have been posited by fringe religious groups. They have no basis in scientific research. The remaining theories are not supported in mainstream science, and therefore, deserve mention (Meet notability), but they are fringe theories as well.

This is getting tiring to say the least. No journal is going to refer to a theory as fringe, just like no journal will say water is wet either. Paranormal Skeptic (talk) 15:52, 25 September 2009 (UTC)

It is unencylopedic to label things fringe as it is a POV judgement call especially if references don't say so. The idea that "if it wasn't for scientology" there would be no controversy is bogus. That is just a myth promoted by the likes of Barkley who works for the drug companies. Why not just use a non-POV word like "minority" and give it due weight or put controversies into context? Instead of all of this POV arguing and editing. You keep reverting anything I add, which is approaching ownership.--Literaturegeek | T@1k? 15:59, 25 September 2009 (UTC)

If we were going to give due weight and whatnot, the controversies wouldn't even be mentioned in the lede of the article. You are lending undue weight to the theories mentioned in the lede. The entire idea of the other theories hinge on one or two proponents in the medical field. Do you consider fringe being what the majority or minority of viewpoints are? Paranormal Skeptic (talk) 16:05, 25 September 2009 (UTC)

The reference by the way of Barkley is a self published source, which should only rarely be used and rarer more in a medical type article. The fact that it is now in the lead is really a misuse of refs.--Literaturegeek | T@1k? 16:00, 25 September 2009 (UTC)

LG, please for the love of god read the WP:FRINGE page. It will take you no more than 5 minutes at most. Please familiarize yourself with what the WP definition of "fringe" is, for the purposes of a WP page. It does not matter how you feel "fringe" should be defined, and furthermore you should know that slinging around the old "pharma shill" fallacy does nothing to bolster your argument. "Fringe" is not a POV term, it is part of Wikipedia policy. ~ Hyperion35 (talk) 16:02, 25 September 2009 (UTC)

Refs do not say fringe, it is you making that judgement. As I stated on my talk page but will say aggain for other readers. All that I ask is that the articles reflect the references. If a theory is rejected by an important review article say by NICE, WHO, NIH etc then state that, say "some people" or a "minority of doctors" believe xyz however, this view is rejected by NIH, NICE, WHO etc. It is like the Hitler article, majority opinion is he was evil, but yet the article does not say "hitler was an evil man", making judgement calls is unencylopedic, just report the facts is all that I ask, I am not trying to edit war facts out of an article. It is like a tabloid newspaper if you do that. Also you and paranormal discussing deletion of the article may have played a role in me trying to improve referencing. Just because wiki has an article on "fringe" does not mean that that gives you or anyone else the right to go "deciding" in article text what to label as fringe and what as not. Wiki has a neutrality policy to but that doesn't mean that I can go and say NIH, NICE were unneutral or such and such is unneutral as that would be an original research judgement call. If something is rejected by NICE, NIH then REPORT IT as the ref says, all I ask is no original research judgements, just REPORT THE FACTS. We are writing an encyclopedia not a newspaper article.--Literaturegeek | T@1k? 16:55, 25 September 2009 (UTC)

Also you both need to familarise yourselves with WP:MEDRS, we now have a self published source in the lead of a medical article, the barkley personal website. Furthermore it is a contested and I alledge misrepresented edit but yet I am the one getting accused of "pushing POVs", huh? Peer reviewed sources should only be in the lead in a medical article, preferable secondary sources.--Literaturegeek | T@1k? 17:03, 25 September 2009 (UTC)

Yep, familiar with it. You know where it says we are to present the prevailing medical opinion? Which is: a) ADHD exist b) Hunter theory, neurodiversity, and social construct theory and any other fringe theory shouldn't even be presented. In fact, according to WP:MEDRS, this article shoulnd't even exists, as it's merely a POV fork.

Screw it. Better things to do on WP than argue if water is wet. Paranormal Skeptic (talk) 17:27, 25 September 2009 (UTC)

Yes and I accept it exists and also the article references it as the prevailing theory. The extreme view that ADHD does not exist is just a very small part of this article, so I disagree that the article "shouldn't exist". Hunter theory, neurodiversity, and social construct theory etc probably shouldn't be in the lead a they are minority views.--Literaturegeek | T@1k? 17:34, 25 September 2009 (UTC)

(outdent) I reworded a misrepresentation of the NICE publication.--Literaturegeek | T@1k? 00:04, 10 June 2010 (UTC)

EDIT to Below: why isn't anything said about it being connected to how we learn to use our Reward System? The connection is so obvious by looking at brain scans comparing dopamine activity of ADHD brain to baseline. Thanks, OasisMikeI've learned a new way of thinking. (talk) 18:00, 31 October 2012 (UTC) Please, can something about this theory fit? differentiation of cause as developmental: infants bond with adults who remain emotionally calm and emotionally available, thus developing a dopamine pathway natural to humans. When deprived of this experience, or forced to defend themselves against harsh emotional environments they are not developmentally capable of handling, they defend themselves by shutting off their dopamine. This self-defense can be described as an "aversion to bonding" emotionally with others, and gets locked in place before the age of two. Because humans have a genetic "drive" to experience dopamine, however, they later form their own pathways. Lacking any road map they often borrow from cultural narratives available (which get it wrong at a basic level, and do not satisfy their needs except briefly). When the drive to access the Human Reward System is not met, it results in Reward Deficiency Syndrome, and a pattern of self-medication often begins by developing behaviors intended to compensate. Dopamine pathways most natural to the human species include emotionally bonded relationships, prayer or meditation, and joy experienced over other's accomplishments or good fortune (Zen "Mudita," not pride). Dopamine pathways popularly considered unnatural to humans include excessive watching of television, drug usage, excessive television viewing, hoarding, alcoholism, smoking cigarettes, sexual addiction and paraphilias, online gaming addiction & cannabis use. (It should be noted hoarding and paraphilias constitute both a result and an end in themselves, in that lacking the ability to concentrate for any period of time on tasks they are not somewhat obsessed with, items build-up and then the patient justifies the build-up in a variety of ways to protect their self-image, often building an addictive pursuit that may provide some brain-chemistry modification, and paraphilias or extreme fantasy helps them focus through their cycle of arousal to completion. I believe this closely follows the narratives of Dr Gabor Mate, which may be called fringe, but...well, from my POV, it fits. I am 50 and was diagnosed a year ago, and have done a lot of reading online (abstracts of brain studies). I know there are separate pages to specific models (RDS & the Conditioned Attentional Avoidance Loop response model) but it would be nice to get them added to either the main or controversies pages, at least as links. What do you folks think? (how do you handle it when the dominant view of the accademic literature has been so heavily clouded by cultural opinion about personal responsibility and punitive justice? - they aren't co-morbid conditions because they don't occur in the normal population at all). Please, tell me I'm crazy...if I am.

 - Crazy talk lookin' for a home below this point --------

[And, where would it fit to add something really fringe, like, um, how television filters out narratives necessary to understand ADHD because they leverage us for our shared learning disability that limits us to television, and that's who paid political advertising works on, a captive audience (Yes, I am saying every dollar spent on political campaigns is betting on swaying someone with a childhood condition, and the net effect is the ADHD population of America is the Corporate swing-vote)...someplace for something real, but that cannot be substantiated?] Thanks for your time! I've learned a new way of thinking. (talk) 10:25, 12 September 2012 (UTC)

A reference supporting the text you would like to add is needed. See this page, WP:MEDRS and WP:NOR. Do you have a good quality reference to support your viewpoint?--MrADHD | T@1k? 20:15, 31 October 2012 (UTC)

Something else...why quote Tom Cruise at all? He's an actor, not an expert on medicine.--41.146.134.100 (talk) 22:22, 4 April 2018 (UTC)

Chromtrops (talk) 21:34, 7 September 2018 (UTC) This 'article' is extremely bias and of poor quality. The obvious clear agenda and bias presented by the small group of authors should publish this to their own private blogs, along with their view of made up Autism and Epilepsy. Mark for deletion. Chromtrops (talk) 21:34, 7 September 2018 (UTC)